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: 403-443-8532
Fax: 403 443-8541
Toll Free: 24 Hour Mental Health Help Line 1-877-303-2642
Toll Free: 24 Hour Addiction Help Line 1-866-332-2322

Is 24 Hour?

Yes

	12:00 AM 12:15 AM 12:30 AM 12:45 AM 1:00 AM 1:15 AM 1:30 AM 1:45 AM 2:00 AM 2:15 AM 2:30 AM 2:45 AM 3:00 AM 3:15 AM 3:30 AM 3:45 AM 4:00 AM 4:15 AM 4:30 AM 4:45 AM 5:00 AM 5:15 AM 5:30 AM 5:45 AM 6:00 AM 6:15 AM 6:30 AM 6:45 AM 7:00 AM 7:15 AM 7:30 AM 7:45 AM 8:00 AM 8:15 AM 8:30 AM 8:45 AM 9:00 AM 9:15 AM 9:30 AM 9:45 AM 10:00 AM 10:15 AM 10:30 AM 10:45 AM 11:00 AM 11:15 AM 11:30 AM 11:45 AM 12:00 PM 12:15 PM 12:30 PM 12:45 PM 1:00 PM 1:15 PM 1:30 PM 1:45 PM 2:00 PM 2:15 PM 2:30 PM 2:45 PM 3:00 PM 3:15 PM 3:30 PM 3:45 PM 4:00 PM 4:15 PM 4:30 PM 4:45 PM 5:00 PM 5:15 PM 5:30 PM 5:45 PM 6:00 PM 6:15 PM 6:30 PM 6:45 PM 7:00 PM 7:15 PM 7:30 PM 7:45 PM 8:00 PM 8:15 PM 8:30 PM 8:45 PM 9:00 PM 9:15 PM 9:30 PM 9:45 PM 10:00 PM 10:15 PM 10:30 PM 10:45 PM 11:00 PM 11:15 PM 11:30 PM 11:45 PM	12:00 PM 12:15 PM 12:30 PM 12:45 PM 1:00 PM 1:15 PM 1:30 PM 1:45 PM 2:00 PM 2:15 PM 2:30 PM 2:45 PM 3:00 PM 3:15 PM 3:30 PM 3:45 PM 4:00 PM 4:15 PM 4:30 PM 4:45 PM 5:00 PM 5:15 PM 5:30 PM 5:45 PM 6:00 PM 6:15 PM 6:30 PM 6:45 PM 7:00 PM 7:15 PM 7:30 PM 7:45 PM 8:00 PM 8:15 PM 8:30 PM 8:45 PM 9:00 PM 9:15 PM 9:30 PM 9:45 PM 10:00 PM 10:15 PM 10:30 PM 10:45 PM 11:00 PM 11:15 PM 11:30 PM 11:45 PM 12:00 AM 12:15 AM 12:30 AM 12:45 AM 1:00 AM 1:15 AM 1:30 AM 1:45 AM 2:00 AM 2:15 AM 2:30 AM 2:45 AM 3:00 AM 3:15 AM 3:30 AM 3:45 AM 4:00 AM 4:15 AM 4:30 AM 4:45 AM 5:00 AM 5:15 AM 5:30 AM 5:45 AM 6:00 AM 6:15 AM 6:30 AM 6:45 AM 7:00 AM 7:15 AM 7:30 AM 7:45 AM 8:00 AM 8:15 AM 8:30 AM 8:45 AM 9:00 AM 9:15 AM 9:30 AM 9:45 AM 10:00 AM 10:15 AM 10:30 AM 10:45 AM 11:00 AM 11:15 AM 11:30 AM 11:45 AM
Monday 8:00 AM - 4:30 PM
Tuesday 8:00 AM - 4:30 PM
Wednesday 8:00 AM - 4:30 PM
Thursday 8:00 AM - 4:30 PM
Friday 8:00 AM - 4:30 PM

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.

If this submission is successful, and you have provided your email address, you will receive an email confirmation.
If you do not receive this, please contact healthlink@primarycarealberta.ca