Which office location(s) would you prefer for your appointment?
Preferred day(s) of the week for an appointment?
Preferred time(s) for an appointment?
Please describe the nature of your appointment (e.g., consultation, check-up, etc.):
Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.
Your Health information at our clinic is protected under the Health Information Act of Alberta.
We will use your health information only to support the health services we provide to you:
Staff at the clinic will only collect and use your information to:
-provide your treatment and care
-verify your eligibility for health services
-conduct investigations or reviews of practice
-complete research under ethical review
-support health provider education, or
-for internal management purposes
We will not disclose your health information to non-health care agencies without your consent:
Except in special family or emergency circumstances, you will be asked for your consent before we give your information to anyone other than another health agency involved in your care.
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