Virtual Appointment

DISCLAIMER

Virtual appointments are only available to patients that have a referral from their family physician.

Don’t have a referral? Have your family physician fax a referral to 780.428.5556. Our specialized referral coordinator will call you to schedule the appointment once the referral is received! Thank you for your interest in Stratica Dermatology!

Why virtual?

Virtual appointments help all patients have access to health care. We are working hard to eliminate the barriers that some patients face by offering the option of virtual appointments for certain skin conditions. Virtual appointment may also be an option for those patients that are location far from our Edmonton location.

Virtual patient intake form

I verify that I have an existing referral with Stratica Dermatology and have been contacted by Stratica Dermatology’s Referral Coordinator already

I am seeing *

Guardian's full legal name if under 18 years old

Association to the Patient

Patient’s First Name *

Patient’s Last name *

Date of Birth *

Gender *

Male
Female
Other

Alberta Healthcare Number *

Email *

Home Phone

Mobile Phone *

Pharmacy Information

Pharmacy Name *

Phone Number *

Fax Number *

Address *

City *

Province *

Postal Code *

PHOTOS OF CONDITION

Photos must be of the same condition referred for
All virtual patients must send photos of condition at least 3 days prior to appointment

Please upload a minimum of 2 images of your condition, maximum of 3 *

Click or drag files to this area to upload. You can upload up to 3 files.

I verify that the attached images showcase my condition clearly. I understand that if the photos are of poor quality, it may affect my appointment date or result in a complete cancellation of the appointment.