Alberta health services personal information form 2026

1. Click ‘Get Form’ to open the alberta health services personal information form in the editor.
2. Begin by identifying who is requesting the information. If you are the patient, complete page 1. If you are not, fill out both pages 1 and 2.
3. In the 'Patient Information' section, enter the patient's last name, first name, date of birth, and personal health number.
4. For 'Requester Information', provide your last name (or check 'Same as above'), mailing address, email address, phone number, and signature.
5. Specify what information you want by checking the appropriate boxes for records such as discharge summaries or test results. Include details about treatment sites if applicable.
6. Indicate how you would like to receive this information—either in person or by mail—and provide any necessary addresses.
7. If requesting on behalf of someone else, complete page 2 with your relationship to the patient and reason for disclosure.

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