New Patients

Register as a new patient.

Complete the form below and our team will set up your profile before your first visit. For any questions, kindly consult with our reception.

Secure, encrypted patient intake
Same-day confirmation for new registrations
Bring your Alberta Health Care card to your first visit

Alberta Health Care No. *Expiry Date *

First Name *Middle Name Last Name *

Email *Date of Birth *

Home Street Address *

City *Province *Postal Code *

Primary Cell Number *Home Number

Gender

MaleFemalePrefer Not To Say

Allergies

None KnownDrugsIntoleranceEnvironmental

Pharmacy Name Pharmacy Address

Emergency Contact

Contact Name Contact Number Relationship

By submitting, you consent to Ranchers Medical Clinic storing this information — including health-related details — to prepare your patient file. Data is encrypted in transit and stored securely. Please bring your Alberta Health Care card and photo ID to your first appointment.