Help me find a doctor

Please complete the form below and click on the submit link to send us your information. You will be added to a waitlist and contacted once a family physician becomes available.

If you wish to complete this form on behalf of another individual: Please be advised that section 104 of the Health Information Act identifies situations in which this is allowed. Please check the box below that applies to the form you are submitting. Your authority to provide and/or receive information about another individual will be verified with you when you interact with your family doctor and/or other PCN health providers.

Read our privacy policy

The personal information you voluntarily provide on this form is collected, used and disclosed to provide health programs relevant to you and your community, in accordance with provisions of Alberta's Health Information Act (HIA). Any personal information we received from you through this site will be handled and stored in a secure manner to protect it from unauthorized access or disclosure. If you have any questions about how we manage your health information, please see our privacy statement.

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Personal Information

In accordance with the Health Information Act of Alberta, I am submitting this form: *

First Name *

Last Name *

Date of Birth *

Month

Day

Year

Gender

Street Address *

City *

Province

Postal Code *

Your Health Needs

Do you prefer a doctor of a specific gender? *

To help us improve our service please indicate why you are looking for a doctor?

Disclaimer

Phone Number *

We will use this to contact you when we have found a doctor

E-mail *

We will use this email to keep you updated on our progress in finding you a doctor

Your contact information is required for your local primary care network and/or community physician to contact you when a physician becomes available. Your primary care network may also be able to offer additional health services of benefit to you while you wait for a family doctor.

I agree to be contacted when a family doctor and/or applicable health service is available and understand that failure to provide accurate contact information will invalidate my form. By submitting this form, I agree to receive electronic communications from the Primary Care Network regarding the availability of a family doctor and/or applicable health services. *

Calgary Zone UAR

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