Patient Confidentiality

An important component of trust is the honest and compassionate communication of information in complete confidence.  Patients give information to physicians/secretary in a unique context where they have the utmost faith that physician/secretary will maintain patient privacy and confidentiality.  By law, physicians and secretaries must safeguard patient information. This means patient information should not be discussed or transmitted to anyone other than the patient without their consent. All medically related questions/concerns must be discussed with a Medical Doctor (MD) only 

No-Show Policy

The Polyclinic Family and Specialty Medicine requests 48 business hours notice for appointment cancellations (for FibroScan and Vasectomy 5 business days notice).  This is so that another patient in medical need may be seen in the time that had been reserved for you.  The charge for your missed appointment varies depending on appointment type.  A note will be made in your chart if you miss an appointment.  You may pay in person at your next visit or phone our office at 416-222-6160 to advise us of the preferred method of payment.  In the event that a patient has missed three appointments without sufficient notification s/he will receive a warning letter about their missed appointments and will be advised that if they miss another appointment, they may dismissed from the practice.

Prescription Refills

Your prescription should be able to last until your next visit but in the event of a new refill we recommend you make an appointment with your doctor so it can be refilled in person. Prescription re-fills via fax or phone is provided by some but not all Polyclinic physicians. Prescription re-fill via fax/phone is an uninsured service and thus the cost is $15 per re-fill.

Uninsured Patients

  • If urgent care is required, uninsured patients from outside Canada may be provided with medical care provided the patient signs a waiver – Governing Law and Jurisdiction Agreement
  • All uninsured patients must pay for their visits under OMA guidelines.
  • Uninsured Charges

Uninsured Services

  • Uninsured services include: sick note for work or school, copy and transfer of medical records, prescription refills over the phone or fax, lost requisitions, writing reports and forms, missed appointments without sufficient notice, long distance telephone charges, cosmetic procedures, routine eye examinations for patients between age 20-64, travel medicine services, etc.
  • Payment for these services can either be mailed to our office or paid by cash/visa/debit at the Main Reception of Family Medicine Department.    A receipt will be provided to you.

Request for Medical Records

If we receive authorization to release any medical records to Third Parties we will always confirm with the patient prior to releasing medical records. Click here for the document.

Patient may always request any of their own medical files and have a right to receive a copy of their medical files.

If you want a copy of a report/results of a test it is $1/page and copy can be printed on the spot.

To get a copy of a full chart patient is charged according to the Ontario Medical Association guidelines: $30 + $0.25/page for each page over 20 pages.  Longer files may not be obtained on the spot and may take some time to print/copy.

For medical records to be transferred to another office a consent form must be signed by the patient. Payment must be provided by patients for the copies requested. Click here for the document.


OHIP patients must present a valid health card at every visit.
IFH (Refuge Clients): If you are covered by Blue Cross insurance, you must present valid documentation and we must place a call to make sure you are covered on the date of the appointment.
Uninsured patients must sign Outside Patients form and also pay OHIP fee prior to appointment.

Patient Complaint Policy

Patients are encouraged to provide feedback if they feel they received inadequate service or if they are in disagreement with the Polyclinic’s policies or procedures.  Please feel free to talk to a manager with any concern you might have or email us at