Referral Form

Puzzle

The Referral Form must be filled out by the child/youth’s pediatrician or family doctor prior to setting up an appointment with the Clinic. When completed and signed, the form can be mailed or faxed to:

Pediatric Weight Clinic
Northland Professional Centre
Suite #407, 4600 Crowchild Trail NW
Calgary, Alberta
T3A 2L6

Phone: (403) 547-8992
Fax: (403) 547-8975