Referral Forms

Please fax completed referrals to: (403) 571-6971

Cardiac Rehabilitation Referral Form

A 12-week medically-supervised exercise and health
coaching program for patients.

Heart Health Assessment Referral Form

Fee for service.  A physician of self-referral for those with one or more risk factors wanting to know their risk for heart disease.

Eligibility Criteria

Cardiac Rehab Program

  • Acute Coronary Syndrome (STEMI, NSTEMI, unstable angina, stable angina)
  • Treated with percutaneous coronary intervention (PCI) or medical management
  • Coronary artery bypass grating (CABG), valve surgery, heart failure

Heart Health Assessment

  • Four or more risk factors for heart disease.

Special Populations

  • Medically managed peripheral artery disease (non-limb threatening ischemia)
  • Ventricular assist device
  • Postural Orthostatic Tachycardia Syndrome (POTS)
  • Prehabilitation (stable patients wait-listed for CABG)