8 hours ago · Direct Primary Care Intake Form. Patients who are new to our Employer Direct Primary Care program should complete this form and bring it with them to their first appointment along with their photo ID, DPC member card, insurance card, and any prescriptions, over-the-counter medications, vitamins and supplements they are taking. >> Go To The Portal
Patients who are coming for a Medicare Wellness Exam should complete this form and bring it with them to their appointment.
Patients who are new to our Employer Direct Primary Care program should complete this form and bring it with them to their first appointment along with their photo ID, DPC member card, insurance card, and any prescriptions, over-the-counter medications, vitamins and supplements they are taking.
Patients who are coming for an ultrasound should review this form in advance, as certain exams require specific preparations.
This form is used to ask one of our offices to send your records to another one of our offices.
CVFP is a patient-based funding model. What this means is that Alberta Health compensates us differently from other fee-for-service physicians. Our clinic receives a monthly fee to provide health services for each person we care for.
If you are interested in becoming a patient at CVFP’s Health Home, we invite you to join our waitlist by completing and sending this form.
Authorization for Release of Medical Information (PDF) - Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility. Autorización De HIPAA Para Divulgar Información Del Paciente
Financial Policy (PDF) - This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.