Electronic Update Request - Service At Location Profile

If you require assistance in completing your change request, hover over the input box and a short description of the field usage will display. Inclusive language should be maintained.

Service Name

Location Name

Confidential

Yes

Descriptive Line/Building Name

Suite

Building Number

Street Name

Street Type

Quadrant

City

Province

Postal Code


Telephone: 403-944-1501 (McCaig Tower, Emergency DI Department)
Fax: 403-592-4762 (McCaig Tower, Emergency DI Department)
Telephone: 403-944-6235 (McCaig Tower, Ground Floor)
Telephone: 403-944-1132 (Special Services Building)
Fax: 403-592-4762 (Special Services Building)
Telephone: 403-944-4139 (Foothills Hospital, 4th Floor Radiology)
Fax: 403-592-4762 (Foothills Hospital, 4th Floor Radiology)
Telephone: 403-270-8491 (Fluoroscopy bookings)

Is 24 Hour?

Yes

Hours of Operation Note

Waiting Period Same As Service:

Yes

Waiting Period

Waiting Time

Waiting Unit

Waiting Period Note

Same As Service:

Yes

Languages

Languages Note

Wheelchair Accessible

Wheelchair Accessible Note

Other Disabled Access

Other Disabled Access Note

Transportation Description

Contact Name *

Please enter contact name.

Title

Telephone *

Please provide a phone number or email.

Email *

Please provide a valid email.

Comments

If No Changes Required to the record, select the checkbox and fill out the "Verification Contact Information" above. An email will be sent to confirm submission.

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If you do not receive this, please contact healthlink@primarycarealberta.ca