Kehilat Shalom

Application Form for
Access to Urgent and Other Dedicated Appointments
for Members of Kehilat Shalom

Cranston Ridge Medical Clinic (CRMC) is pleased to provide urgent medical appointments for acute, non-chronic conditions to members of Kehilat Shalom in Calgary. Appointments are typically available the same day or the following day and are primarily offered by our Registered Nurse Prescribers.

Examples of conditions we can assess and treat include (but are not limited to): mild acne, allergic rhinitis (runny nose due to allergies), atopic dermatitis (eczema), cold sores, bacterial/viral/allergic conjunctivitis, candidal diaper dermatitis, emergency contraception, erectile dysfunction, gastroesophageal reflux disease (GERD), headaches, hemorrhoids, hormonal contraception, colds, cough, influenza, pneumonia, insect bites, musculoskeletal sprains and strains, obesity, onychomycosis (toenail fungus), oral aphthous ulcers (canker sores), oral thrush (candida), shingles, bacterial and fungal skin infections, tobacco cessation support, and urinary tract infections.

Members of Kehilat Shalom may also call CRMC simply for nursing advice—whether to clarify how to manage a condition, or to better understand whether a situation requires urgent attention, without the long wait times often associated with calling 811.

In addition, CRMC provides immigration medical appointments for Israel, including assessments for Aliyah, Sar-El, Taglit, and Magen David Adom.

If you are a member of Kehilat Shalom and would like access to these services, please complete the registration form below. Once confirmed, you will be registered as a walk-in patient for non-chronic urgent care or nursing advice with one of our advanced practice nurses. Please note: registering for this program does not register you as a regular patient of the clinic. If you wish to register as a regular patient with one of our physicians, you must first register through this program as a walk-in patient and then contact our front desk to request full patient registration.

For more information, please check the FAQs section of this service by clicking here.

First Name of Applicant

Last Name of Applicant

Sex

Email of Applicant

Full Address of Applicant

Date of Birth of Applicant

Alberta Health Services Card Number

Mobile Phone of Applicant

Emergency Contact Number

Municipality

Postal Code

The applicant is Required

A Canadian Citizen

A Canadian Permanent Resident

The holder of a Temporary Permit

For temporary permit holders, please indicate the date of expiry of your AHS card

DECLARATION: By signing below, I acknowledge that I am not being registered as a patient with any provider at this clinic. I understand that I am only being pre-registered for walk-in services or to request advice from one of the Registered Nurses at CRMC today and for the future. If, at a later stage, I wish to register with a provider at this clinic, I must apply directly through the clinic’s standard registration process after first registering as a walk-in patient. By signing below, I also agree to Cranston Ridge Medical Clinic confirming my identity with Kehilat Shalom for security reasons.

Date of Application

Signature of Applicant

Thank you for applying to register with the walk-in service available to members of Kehilat Shalom at CRMC. On receipt of your application, we will call you back at the number you provided above to confirm your details.

Application Form for Access to Urgent and Other Dedicated Appointments for Members of Kehilat Shalom

Application Form for
Access to Urgent and Other Dedicated Appointments
for Members of Kehilat Shalom