New Patient Registration | Crossfield Clinic

First name

Last name

Birthday

Year

Month

Day

Alberta Health Insurance #

Phone Number - Note that appointment reminders will be sent to this number. Cell numbers preferred

Mailing Address

Email address: (Please note that due to privacy rules - all adults and children over 14 require a separate email address)

If you are looking for a new provider please select from list below:

Dr. Marc Ascione - accepting new patients

If this person is a minor, please include names of parents/guardians

Please check if you understand that you will have 36 hours to accept Ava Connect invitation once it has been sent.

Once you are set up on Ava Connect please book a Meet and Greet with your practitioner within 6 months.

You are not officially a patient until you have been seen in office.

New Patient Registration form