New Patient Registration

BFG Medical Clinic is now accepting new patients.

If this is an emergency, do not contact us via email, please use our emergency contact information.

First name *

Last name *

Date of Birth *

Gender *

Male

Female

Phone *

Phone Number

Email *

Email address

Address *

Current Address

Alberta Health Care #

Do you have any active medical history?

What would you like to visit the doctor for?

How urgent is this? *

1

2

3

4

5

6

7

8

9

10

1 - Not at all and 10 - Very urgent

Are you taking any medication? *

No Yes

If Yes, what are the medications for?

If Yes, please specify.

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