This intake form is for persons that would like to schedule an appointment to become a new patient of a Family Physician at Westside Medical Clinic. All new patients are required to fill out this intake form for accuracy of demographic information. Please enter the information exactly as it is on your Alberta Health Care Card.
Please be aware that if you do not show up, or fail to cancel this appointment, you won’t be able to reschedule it.
One form is required for each family member you would like a file to be created for. You will become a new patient of Westside Medical only after you have signed the “New Patient Clinic Protocol”. We respectfully request the signed document within 4 weeks of your initial appointment. Thank you.
Please do not use this form for medical advise, urgent appointment request, request for specialist referrals, forms to filled out, prescription refills , fax requests of lost requisitions or prescriptions, for all of those requests please book an appointment to see your doctor. Staff members can not fax lost prescriptions or lost requisitions.
NEW PATIENT INTAKE FORM