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Our online self-referral form is the fastest way to book your appointment. Complete the information below and we will call you within two business days to complete your booking.

Physician Referrals

To refer a patient, please download our fillable PDF Patient Referral form and fax the completed form to 403 254 6693.

First Name^*

Last Name^*

Phone^*

Email^*

Gender^* Female Male

Birth Date (MM/DD/YYYY)^*

Address^*

City^*

Province^*

Postal Code^*

Personal Health Care No.

Primary Sleep Concerns*

Obstructive Sleep Apnea Insomnia Excessive Daytime Sleepiness Shift Work/Jet Lag

Movement Disorders Parasomnia Athlete Safety Sensitive Occupation

Safety Sensitive Occupation*

Professional Driver Airline Pilot/Flight Staff Railroad Engineer/Conductor First Responder (EMS/Police/Fire)

Doctor/Nurse Oilfield Worker Other:

Additional medical information

* Required fields

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