Your Information Patient first name* Patient last name* Phone* Email* Birth year* Year193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019 Birth month* MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Birth day* Day12345678910111213141516171819202122232425262728293031 Preferred appointment date & time Location* Preferred LocationCalgary CentralCalgary ChinookCalgary NorthCalgary SouthCalgary University DistrictCranbrook, BCCreston, BCFernie, BCGolden, BCInvermere, BC Scheduled year* Year20242025 Scheduled month* MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Scheduled day* Day12345678910111213141516171819202122232425262728293031 Time of day* 9AM - 12:00PM12:00PM - 4:30PM