Forms

 

The following forms are available in PDF format only.

All patients who have not previously been seen at Ridgeview Medical Centre must fill out a new patient form upon arrival. It is important for new patients to bring their health care card with them, along with proof of identity. If no health care number is provided, a basic fee will be levied with payment to be made at the time of the appointment.

 

New Patient Forms

Click here to download the PDF file: New Patient Form.pdf

Jurisdiction Agreement

Out of country patients will be asked to sign a jurisdiction agreement. Briefly, this agreement states that any disputes arising from the doctor-patient relationship will be governed by the laws of Alberta, and Canada where applicable. Further, should the patient wish to commence any legal proceedings, they will be commenced only in Alberta, with the Courts of the Province of Alberta having exclusive and preferential jurisdiction.

Click here to download the PDF file: Jurisdiction Agreement.PDF

Consent for Transfer of Medical Files

New patients may need to have medical files transferred to Ridgeview from their previous physician's office. The patient must authorize the release of any medical files with the signing of a consent form. This is an uninsured service, and a charge may apply.

Click here to download the PDF file: Transfer of Medical Files.PDF

Colonoscopy / Endoscopy Form

Prior to surgical and endoscopic procedures, patients will be asked to fill out a medical questionnaire which will be sent to Dr. Pagenkopf at the Canmore General Hospital.

Click here to download the PDF file: Colonoscopy / Endoscopy Form

 

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