Health Information Access Request form - Alberta Health 2026

1. Click ‘Get Form’ to open the Health Information Access Request form in the editor.
2. Begin by filling out the 'Patient Information' section. Enter the patient's last name, first name, date of birth, and personal health number.
3. In the 'Requester Information' section, provide your last name, first name (if different from the patient), mailing address, phone number, city/town, province, postal code, and date.
4. Indicate who is requesting the information by selecting either 'I am the patient' or 'I am not the patient'. If you are not the patient, complete both pages of the form.
5. Specify what information you want by checking all applicable boxes under 'What information do you want?'. Include details about treatment sites and dates if necessary.
6. Choose how you would like to receive this information: in person or by mail. Provide any additional mailing address if needed.
7. If requesting someone else's health information, complete page 2 with your relationship to the patient and reason for disclosure. Check appropriate authority boxes and attach supporting documents.

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