Vasectomy Intake Form - Horizon Family Medicine

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110 – 6845 66 Street
Red Deer, AB T4P 3T5

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Horizon Family Medicine

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Please provide as much information as you can, and we will connect with you to complete your appointment,

Pricing for Travel Medicine Consultations:

Individual: $80
Complex Multi-Country: $95
Couple: $130
Family (up to four): $180
Additional child: $35 each

Travel medicine consultations are an uninsured, patient pay service and are not covered by Alberta Health.

Your name

Your email

Phone Number

Address

Destination

Weeks to Departure

Adult Family Members Attending

Child Family Members Attending

Message (optional)

Your name

Your email

Phone Number

Message (optional)

Your name

Your email

Phone Number

Cover Letter (optional)

Attach CV (pdf & doc files only; 10mb max)

Your name

Your email

Phone Number

Position you are applying for

Cover Letter (optional)

Attach Resume (pdf & doc files only; 10mb max)

Family Medicine
Pregnancy Care
Sports Medicine
Travel Medicine
Vasectomy Services

Young Male Doctor helping a child held by a parent

Young Pregnant Woman holding her belly

Woman nursing shoulder injury

Woman walking down a foreign street

Man looking up at the camera

Please provide as much information as you can, and we will connect with you to complete your appointment,

Pricing for Travel Medicine Consultations:

Individual: $80
Complex Multi-Country: $95
Couple: $130
Family (up to four): $180
Additional child: $35 each

Travel medicine consultations are an uninsured, patient pay service and are not covered by Alberta Health.

Your name

Your email

Phone Number

Address

Destination

Weeks to Departure

Adult Family Members Attending

Child Family Members Attending

Message (optional)

Family Medicine
Pregnancy Care
Sports Medicine
Travel Medicine
Vasectomy Services

Young Male Doctor helping a child held by a parent

Young Pregnant Woman holding her belly

Woman nursing shoulder injury

Woman walking down a foreign street

Man looking up at the camera

Family Medicine
Pregnancy Care
Travel Medicine

Young Male Doctor helping a child held by a parent

Young Pregnant Woman holding her belly

Woman walking down a foreign street