Updated August 2026, Current Ontario ESA and CPSO telemedicine standards.
Need a sick note in Ontario? MedLetter provides official physician-signed documentation for $49 with same-day delivery. No walk-in clinic visit needed — submit your request in 2 minutes and receive your note by email. Valid for employers, universities, and insurance across Ontario.
Yes, Doctors Can Refuse
In Ontario, physicians are not obligated to provide sick notes. While it might seem like a simple administrative task, issuing a medical certificate is a professional act that requires a physician to exercise clinical judgment. The College of Physicians and Surgeons of Ontario (CPSO) outlines clear guidelines regarding when and how doctors should issue these documents. If a doctor feels they cannot ethically or medically justify the note, they have the right, and sometimes the professional obligation, to refuse.
Common Reasons for Refusal
Doctors in Ontario face immense pressure, balancing patient care with administrative burdens. Here are the most common reasons a physician might decline your request for a sick note:
- Haven't seen you recently and can't assess your condition: If you are asking for a note for an illness that occurred last week and you are now fully recovered, a doctor cannot retroactively verify your symptoms.
- Don't believe symptoms warrant time off: A mild sniffle might not meet the clinical threshold for requiring time away from work, especially if your job duties are not physically demanding.
- Policy against backdating notes: The CPSO strongly discourages backdating medical documents. A doctor can only attest to what they observe on the day of the assessment.
- Request seems for convenience rather than medical necessity: If a doctor suspects the request is to extend a vacation or avoid a specific work task, they will refuse.
- Too busy (especially during flu season): During peak illness seasons in cities like Toronto, Ottawa, and Mississauga, clinics are overwhelmed. Doctors may prioritize urgent medical care over administrative paperwork.
What to Do If Refused
Being denied a sick note can be stressful, especially if your employer is demanding one. Here is a step-by-step guide on how to handle a refusal:
1. Ask for their specific reason: Understanding why they refused can help you address the issue. Is it a lack of medical evidence, or simply a clinic policy?
2. Address their concerns if possible: If they need more information about your job duties to understand why you can't work, provide it.
3. Seek a second opinion: You have the right to consult another healthcare provider.
4. Consider an online service: Telemedicine platforms like MedLetter offer a convenient alternative when your primary care provider is unavailable.
5. Document the refusal: Keep a record of the date, time, and reason for the refusal. This can be helpful if you need to explain the situation to your employer or HR department.
The Urgency of Sick Notes in Ontario
The demand for sick notes often arises in high-stress, urgent situations. Consider these common scenarios faced by Ontario workers:
- The Demanding Boss: Your manager at a busy Amazon warehouse in Brampton (Bramalea, Heart Lake, Springdale, and surrounding areas) or a fast-paced tech startup in Kitchener demands a note by tomorrow morning, or you face disciplinary action.
- The After-the-Fact Request: You called in sick on Monday with a severe migraine. It's now Wednesday, you're back at work at TD Bank in downtown Toronto, and HR suddenly asks for documentation for your absence.
- The Weekend/Evening Dilemma: You fall ill on a Friday evening. Your family doctor in London is closed until Monday, and the local walk-in clinics have hours-long waits or are no longer accepting patients for the day.
In these situations, the traditional healthcare system often falls short, leaving employees scrambling to fulfill employer requirements while trying to recover from their illness.
When Online Services Help
New sick-note requests are temporarily paused while we review our service. We are not accepting new orders at this time. can be helpful when your family doctor is unavailable or you've been refused by a walk-in clinic doctor who doesn't know your history. Online services bridge the gap for Ontarians who need timely documentation without the hassle of waiting rooms.
Important Note
MedLetter physicians conduct genuine medical assessments. If a physician determines your situation doesn't warrant a sick note, they may decline, and you'll receive a full refund. Our CPSO-registered doctors adhere to the same professional standards as in-person clinics.
Ontario Employment Standards: Your Rights
Under Ontario's Employment Standards Act, 2000 (ESA), employees are entitled to 3 unpaid sick days per year (some employers offer paid days). Important provisions:
- Employers cannot require a doctor's note for ESA-protected sick days as of January 2024 (Working for Workers Act amendments)
- The Ontario Human Rights Code requires employers to accommodate medical conditions to the point of undue hardship
- Federally regulated employees in Ontario get 10 paid sick days under the Canada Labour Code
- Many Ontario employers (including Shopify, TD Bank, RBC, Amazon, Loblaws, and government agencies) still request notes as a matter of company policy (distinct from legal requirement)
Despite the Working for Workers Act, many large employers, such as the Ontario Public Service, TTC, and OPG, have complex absence management policies that may still trigger requests for medical documentation for extended absences or specific circumstances.
Statistics: Healthcare Access in Ontario
According to Ontario Health and Statistics Canada (2025-2026):
- 2.3 million Ontarians lack a regular family doctor or nurse practitioner
- Average emergency room wait time in Ontario: over 4 hours for non-urgent cases
- Walk-in clinic wait times in the GTA: 1.5-3 hours on average
- Ontario has the lowest physician-to-population ratio of any large province
These statistics highlight why obtaining a sick note through traditional channels can be so difficult and why doctors, overwhelmed with patient loads, might refuse requests they deem non-essential.
Comparing Your Options for a Sick Note in Ontario
When you need a sick note, you have several options. Here is a comparison to help you decide the best route:
| Option | Average Cost | Typical Wait Time | Convenience | Best For |
| :--- | :--- | :--- | :--- | :--- |
| Family Doctor | $20 - $50 | Days to Weeks | Low (requires appointment and travel) | Complex, ongoing medical conditions requiring detailed documentation. |
| Walk-in Clinic | $20 - $40 | 1.5 - 4 Hours | Medium (no appointment, but long waits) | Urgent needs when you don't have a family doctor, but you must be prepared to wait. |
| MedLetter (Online) | $49 | 2 - 6 Hours | High (apply from home, same-day delivery) | Quick, straightforward illnesses (colds, flu, minor injuries) requiring fast documentation for employers. |
| Emergency Room | $20-50 (note fee) | 4+ Hours | Very Low (long waits, high exposure to illness) | True medical emergencies only. ER doctors often refuse simple sick note requests. |
Practical Steps for Ontario Employees
1. Know the ESA - Your your employer faces consequences for penalizing you for taking your 3 statutory sick days
2. Check your employment contract - Many Ontario employers (including Shopify, TD Bank, RBC, Amazon, Loblaws, and government agencies) offer 5-10 paid sick days beyond the ESA minimum
3. Unionized workers - OPSEU, CUPE, and Unifor contracts typically provide 12-18 paid sick days annually
4. Document everything - Keep a record of when you called in and who you spoke to
5. Accommodation requests - If you have a chronic condition, consider requesting formal workplace accommodation under the OHRC
When a Sick Note May Not Be Required
Under Ontario law, while the ESA provides some protection for short absences, smart employees still get documentation for:
- Your 3 annual ESA sick days (Working for Workers Act, 2024)
- Family responsibility leave (up to 3 days)
- Bereavement leave (up to 2 days)
- Domestic or sexual violence leave
If your employer insists on a note for these protected leaves, you may need to remind them of your rights under the ESA or consult with the Ministry of Labour.
Frequently Asked Questions
Can I get a sick note online in Ontario?
Yes. CPSO-licensed physicians can assess patients through virtual consultations and issue legally valid sick notes accepted by Ontario employers (including Shopify, TD Bank, RBC, Amazon, Loblaws, and government agencies).
How much does an online sick note cost in Ontario?
MedLetter charges a flat $49 for a sick note with same-day delivery. This includes the physician assessment and official documentation.
Will my Ontario employer accept an online sick note?
Yes. The College of Physicians and Surgeons of Ontario recognizes virtual care. Online sick notes are legally equivalent to in-person notes.
How long does it take to get a sick note from MedLetter?
Most sick notes are delivered within 2-6 hours of submission. Same-day delivery is standard.
Can my employer fire me if a doctor refuses to give me a sick note?
If you are taking one of your three ESA-protected sick days, your employer cannot fire you or penalize you for not providing a sick note, as the Working for Workers Act prohibits them from asking for one for these specific days. However, for extended absences not covered by the ESA, failure to provide requested medical documentation could lead to disciplinary action, depending on your company's policies and your employment contract.
What if my employer rejects my online sick note?
Employers in Ontario are generally required to accept medical certificates issued by licensed physicians, regardless of whether the assessment was conducted in-person or via telemedicine, provided the note contains the necessary information (e.g., confirmation of illness, expected duration of absence). If an employer rejects a valid note from a CPSO-registered doctor, they may be in violation of human rights or employment standards legislation.
Does OHIP cover the cost of a sick note?
No. The Ontario Health Insurance Plan (OHIP) covers medically necessary services. The completion of forms and medical certificates, including sick notes for work or school, is considered an uninsured service. Therefore, doctors and clinics are permitted to charge patients directly for these documents.
Related: Sick Note Ontario, Complete City Guide | Ontario Sick Note Cost 2026 | How to Ask Your Doctor for a Sick Note