Fill Out Pain Management Requisition Form
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We want to help you prepare for your appointment with our secure and convenient online pain management requisition form. Our team can review your form to help ensure we are ready to welcome you for your appointment.
Please fill out the form below from the comfort of your own home and at your convenience.
Our Locations
Grande Prairie
All Services
Contact Us
- 780.532.5648
- 780.513.2074
- [email protected]
Our Address
9815 97 Street #108Grande Prairie, AB T8V 8B9
Hours of Operation
La Crete
Ultrasound Only
Contact Us
- 780.928.2060
- 780.928.2285
- [email protected]
Our Address
Unit 1A 10402 – 100 stLa Crete, AB T0H 2H0
Hours of Operation
Peace River
Ultrasound Only
Contact Us
- 780.624.0073
- 780.624.0718
- [email protected]
Our Address
Sunrise Medical Centre 6789 103 Ave.Peace River, AB T8S 0B6
Hours of Operation
High Prairie
Ultrasound Only
Contact Us
- 780.523.2740
- 780.523.3861
- [email protected]
Our Address
5101 38 streetHigh Prairie, AB T0G 1E0
Hours of Operation
Fairview
Ultrasound Only
Contact Us
- 844.835.0192
- 587.404.0507
- [email protected]
Our Address
10208 110th StreetFairview, AB T0H1L0
Hours of Operation
All Services
Contact Us
- 780.532.5648
- 780.513.2074
- [email protected]
Our Address
9815 97 Street #108Grande Prairie, AB T8V 8B9
Hours of Operation
Ultrasound Only
Contact Us
- 780.928.2060
- 780.928.2285
- [email protected]
Our Address
Unit 1A 10402 – 100 stLa Crete, AB T0H 2H0
Hours of Operation
Ultrasound Only
Contact Us
- 780.624.0073
- 780.624.0718
- [email protected]
Our Address
Sunrise Medical Centre 6789 103 Ave.Peace River, AB T8S 0B6
Hours of Operation
Ultrasound Only
Contact Us
- 780.523.2740
- 780.523.3861
- [email protected]
Our Address
5101 38 streetHigh Prairie, AB T0G 1E0
Hours of Operation
Ultrasound Only
Contact Us
- 844.835.0192
- 587.404.0507
- [email protected]
Our Address
10208 110th StreetFairview, AB T0H1L0
Hours of Operation
Our Services
- Diagnostic Imaging
- X-Ray
- Ultrasound
- GI Studies
- Echocardiography
- Elastography
- Our Locations
- Grande Prairie
- High Prairie
- La Crete
- Peace River
- Fairview
-
Grande Prairie
- 9815 97 Street #108
- Grande Prairie, AB T8V 8B9
-
P: 780.532.5648
[email protected]
-
La Crete
- Unit 1A 10402 - 100 st
- La Crete, AB T0H 2H0
-
P: 780.928.2060
[email protected]
-
Peace River
- Sunrise Medical Centre 6789 103 Ave.
- Peace River, AB T8S 0B6
-
P: 780.624.0073
[email protected]
-
High Prairie
- 5101 38 street
- High Prairie, AB T0G 1E0
-
P: 780.523.2740
[email protected]
-
Fairview
- 10208 110th Street
- Fairview, AB T0H1L0
-
P: 844.835.0192
[email protected]