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Forms and Fees (Halifax)

Forms

Completion of Forms & Letters by a Physician 
If you would like to request completion of a form or letter by your physician, please submit the form and request to medforms@dal.ca to the attention of your physician. Before submitting your form for the physician to complete, please provide any information that you are required to fill in as the patient (e.g. consent for physician to complete form).

We will provide the document to your physician and advise you of the cost of completion and whether a visit is required to obtain the completed form. Payments for forms/letters must be made prior to pick-up and can be made online, in person, or over the phone at 902 494 2171. Information about uninsured services (not paid by MSI, other provincial insurers or DSU International Plan) is available.

Disability Tax Credit Form 
If you are requesting completion of the Disability Tax Credit Form by your physician, please follow the steps below:

  1. Book an appointment with your physician.
  2. Complete Part A - Individual’s Section (pages 1-2) of the form prior to your appointment. Bring this form with you to your appointment, or if you have completed Part A online, you must provide the reference number to the physician at your appointment.
  3. Your physician will review the form and complete Part B - Medical Practitioner’s Section (pages 3-16). 
  4. A fee of $65-$200 (based on time spent for completion) applies for completion of the form and must be paid before the form is released. * As per the Doctors NS guide to non-insured services.
See all forms

Fees

Uninsured immunizations (as of January 2026):

Gardasil (HPV) $215
Hepatitis A (Havrix A) $70 
Hepatitis B $40
Twinrix (Hepatitis A & B) $90
TB Testing (Mantoux 2 Step, 2 injections required) $90
TB Testing (Mantoux 1 Step, one injection only) $45
Tetanus (TDAP) Boostrix and Tray Fee $20

Other commonly requested uninsured services and related fees:

Crutch Rental $75 deposit (returned when crutches are returned)
Liquid Nitrogen $10
Diving Physical (including form completion) $150
Other Physical (including form completion) $120
Uninsured Tray/Procedure Fee $40-50, except Vasectomy $200

Missed Appointment Fees
Make a Payment
Uninsured services (not paid by MSI)
Payment for Physician Appointments (Quebec students)