TORONTO -- As private health services such as dentists, chiropractors and physiotherapists begin to reopen, some have opted to tack on a COVID-19 surcharge in an effort to recoup money spent on new sanitation.

However, some experts warn that the move may deter clients.

University of Toronto finance professor Lisa Kramer explained that these "COVID fees" are designed to help cover the cost of personal protective equipment (PPE), increased sanitation measures and income lost from reduced customer capacity due to physical distancing.

"Many businesses are facing increased costs associated with maintaining a sanitary environment or paying employees higher wages to offset some of the increased risks," Kramer said in a phone interview with on Tuesday.

Kramer said the added surcharge may be necessary for some private health services because their sanitation procedures have increased from what they were before the pandemic.

"In some cases we're seeing that the sanitary practices actually extend beyond what they would have previously been regulated to maintain. For example, some clinics are disinfecting waiting room areas multiple times a day, which wouldn't have previously been required," Kramer said.

"That costs the business money... by having to actually spend time doing that activity and getting the additional equipment to carry it out."


Hair salons and restaurants were among the first to embrace the surcharge in provinces where they have been allowed to reopen, such as British Columbia, tacking on anywhere between $2 to $10. However, the charge issued by private health services may be much higher than a few dollars.

"They're having to spend a great deal of time in between clients sanitizing the chair that the client was sitting in, sanitizing all of the equipment that they might have come into contact with, so it's quite a bit more time consuming and this is going to reduce their take home pay," Kramer said.

Ottawa resident Stephanie Platero told that she received an email from her dental office on June 12 notifying her that the office would be charging clients an $18 COVID fee.

Platero said she was shocked when she received the email because it did not explain what that charge covers or how the added fee would be used to maintain public health regulations.

"They're a dental office so for me, PPE is kind of part of what they already do as part of their routine. I understand that they have an increase because of COVID but with no explanation of where that $18 per client is going... That charge is just too high," Platero said in a phone interview on Tuesday.

Platero has not had time to contact her dental office to get more details but said she plans to. Platero's dental office did not respond to's request for comment.

"I feel slightly taken advantage of. I am very grateful to have a job and to be in a position where I technically could pay that but it seems too high to me without being given any kind of background," Platero said. "If that's a cost that I'm going to have to incur I want to know where it’s going."

The Royal College of Dental Surgeons of Ontario says dental clinics are at "high risk" of spreading COVID-19 without careful planning and appropriate guidance.

Toronto-based dentist Dr. Robert Cappell previously told CTV News that he spent tens of thousands of dollars retrofitting his office with glass partitions to prevent the spread of droplets and adding new medical filters to purify the air.

On top of that, he has stockpiled PPE to protect everyone who steps into his clinic.

"I want to make my patients safe, I want to make my staff safe. And whatever it takes to make them feel comfortable is what we're going to do," Cappell said.

Canadian Dental Association (CDA) spokesperson Zelda Burt told in an email that some dental offices may charge a fee or increase the price of some procedures to help offset the costs for the additional safety measures.

"An aspect of the cost increase comes as a result of additional enhanced personal protective equipment (PPE) requirements by health authorities and other regulators. The cost factor is compounded by rising prices of PPE due to world wide shortages," Burt said Thursday.

"The Canadian Dental Association understands the need to balance the increased costs of delivering dental care with accessibility. The CDA continues to work with the profession, insurers and governments to minimize costs related to barriers of accessing oral health care," she added.

Platero said the situation with her dental office has encouraged her to search for other dentists in the area to inquire about what they are charging amid the pandemic.

"The biggest thing with COVID is that we say we're all in this together, and yet there's certain businesses that I feel are taking advantage of some people," Plater said.

"As a client of theirs, I am considering moving to another dentist that is more reasonable in its response to reopening," Plater added.

Kramer warned that adding a COVID surcharge is a delicate balance for businesses to strike at a time when consumers are already concerned about their finances.

"Many businesses are facing increased costs associated with maintaining a sanitary environment or paying employees higher wages to offset some of the increased risks," Kramer said. "But they have to keep in mind that consumers are also struggling financially."


In addition to dental practices, chiropractors and physiotherapists are among health practitioners that may consider adding a COVID surcharge.

In a statement emailed to, the Canadian Chiropractic Association said it does not set or offer guidelines on how individual practitioners set their fees.

"We support chiropractors to make the best decisions in the interest of their clinical practice while being open and transparent with their patients," the statement read.

Viivi Riis, President of the Canadian Physiotherapy Association (CPA), told on Tuesday that her organization also does not regulate individual practices’ pricing. However, she said practices should add a fee with caution as it may deter some clients.

"We really want Canadians have access to physiotherapy services, and we can save costs to the healthcare system in the long-term. But in the short-term right now, members with private practices are struggling to stay afloat. If the bulk of them have to go under, then Canadians will have less access to necessary care," Riis said in a phone interview.

"But at the same time we also don't want Canadians to say, 'I can't afford that extra charge'… We're not in favour of putting barriers in front of patients who need treatment," she added.

While some physiotherapy clinics may have to increase costs right now, Riis said she hopes businesses will quickly find ways to operate as normally as possible amid the pandemic without applying any extra fee.

"There are going to be a lot of things that will shift and adjust in the future, but I can't be critical of those members who are trying to keep their practices alive right now," Riis said.

She explained that private health care is a competitive market and many of the CPA's members are smaller clinics that have had to incur additional costs by purchasing PPE after losing revenue from being closed for months. To make matters tougher, those businesses are now having to reduce their patient volumes to comply with physical distancing.

"All through COVID people have still been breaking limbs, having car accidents, having strokes, heart attacks, chronic conditions have persisted, so there are many people who continue to need treatment and are in fact waiting to start treatments, so we don't want these businesses to go under," Riis said.


Kramer said businesses will have to be transparent with customers in choosing to adopt a COVID-19 surcharge.

Surcharges are typically a temporary measure introduced to cover a sudden rise in cost, and Kramer said businesses should be clear not only with how much the fee will cost customers, but also how long it will be in place.

She said COVID fees will likely be in place "as long as the virus remains a problem."

"Until we have a vaccine, or very effective treatments, these businesses are going to be facing increased costs so the surcharge will likely be necessary for the duration," Kramer said.

However, she said if the business specifically calls the additional fee a COVID-19 surcharge, then it is expected that that fee will be removed once the pandemic ends.

Any business that tacks on a surcharge must disclose the added fees upfront and clearly communicate those changes to customers, Kramer said. She added that customers should also be able to visually confirm what that charge is being put towards upon arriving at the business.

"If you walk into a waiting room, and you don't see any hand sanitizer or the environment doesn't appear to have been recently cleaned, that wouldn't be a good signal and it wouldn't be consistent with the business' claim that they're actually churning out additional cleaning," Kramer said.

Kramer said the surcharge should be used to cover additional costs incurred by a business amid the pandemic, as opposed to raking in extra profits.

"It's really important for businesses to be completely transparent about the purpose of these surcharges and be honest in carrying that out. Trust with their clients is of paramount importance, and so honest disclosure is really essential," she said.