Medical Doctor Appointment Requests

To request an appointment with a medical doctor at MAUD, please fill out the form below or come visit us in person.

We are a specialty clinic aimed to provide access to equitable vaginal healthcare.
Please note while we try to make room for all, we are not a walk-in clinic. In addition, we are not a general family practice or urgent care.

After completing this form, expect to hear from our team via email within 3-4 business days.
If you have any questions, please send us a message at hello@maudmedical.com

Please Note: A physician referral is required for a Medical Doctor appointment if your reason is not listed below.

Reason for Appointment

Please indicate your reason for seeking medical care at MAUD:

Full Name

The name indicated on your provincial healthcare card.

First Name

Last Name

Date of Birth

Your birthday is used to gain access to your intake form and is required to make your chart

YYYY

Provincial Health Care Number

Found on your health care card. Please provide the province if it is outside of Alberta. If you do not have an Alberta health care number we will additionally ask you for a credit card number upon booking.

Mobile Phone Number

Provide us with the best number we can reach you between 8:30am - 6pm

(###)

###

####

Checkbox

Equality healthcare is efficient healthcare. It is everyones responsibility to work together to respect our public healthcare system.

I understand and agree that any appointments missed, forgotten or cancelled within 2 business days of the scheduled appointment will be subject to a fee of $100. There will not be another appointment booked until full payment is received. I will advocate for my own health by following up after completing any diagnostic imaging, lab tests, prescriptions and referrals to specialists. 'No news' does not mean 'good news'. I understand MAUD Medical clinic is a specialty clinic. I am responsible for finding my own family doctor to help manage my day to day healthcare needs and continuity of care.

Where Did You Hear About Maud?