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Calgary Pediatric Clinic
Home >> Forms

referral forms

​Our Specialists accept self-referrals or referrals from your family physician. 
Download either of the forms below and fax to 587-332-0601 or email it to info@mykidz.ca once completed
Physician referral form
File Size: 105 kb
File Type: pdf
Download File

Patient Self-referral Form
File Size: 191 kb
File Type: pdf
Download File

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General Forms

Patient Registration Form
File Size: 283 kb
File Type: pdf
Download File

Medication Records Form
File Size: 51 kb
File Type: pdf
Download File

Release of Patient Information Form
File Size: 212 kb
File Type: pdf
Download File

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