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Application Form for
Access Cards and Electronic Single Entry Permits for
Cranston Ridge Medical Clinic & Cranston Smart Drug Mart

Cranston Ridge Medical Clinic and Cranston Smart Drug Mart adopt a very high standard of security within their premises. This means that unless you are a booked patient, in order for you to access any areas inside the building past the reception desks, you require a permit. Exception made for employees, volunteers, and students of CRMC/CSDM. In order for us to release such permit or access card to you, you must fill out this form and upload the required documentation mentioned in it. Please be advised that if a member of staff of CRMC or CSDM asks you to leave the premises, you must do so immediately under penalty of trespassing. CRMC/CSDM reserve the right to cancel your Access Card or Electronic Single Entry Permit at any time and for any reason. This application form is HIA, HIPAA, and PIPA compliant.

Date of Birth of Applicant
Year
Month
Day
Is the Access card for use in CRMC only or also in CSDM?
CRMC ONLY (Clinic Only)
CRMC & CSDM (Clinic & Pharmacy)
I am applying for:
An Access Card
An Electronic Single Entry Permit
Date of Application
Year
Month
Day
Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

You may use your mouse to sign inside the box, or you may choose to upload your signature as a file, or you may choose to type your signature. All three forms are legally accepted in Alberta.

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