Physician Referral

To refer a patient, fill out the web form below or complete the PDF and fax it to 403-254-6693.

To submit the patient referral form online, fill out the form below and hit submit once completed. Our team will be in touch soon!

Patient Information

Sex *

Referring Physician

Reason for Referral

Reason for Referral
Hypoventilation *
Medically Stable *

Medical History

Medical History

Investigations

Investigations (Please Include Most Recent)
Special Needs *

Current Medications