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(403) 212-6099 Floor 2, Unit 3, 4624 16 Ave NW Request Appointment

Online Registration and Booking Request

Please fill out this form if you are looking to register as a new patient or to request an appointment. Once submitted, a representative from Rehoboth Medical Clinic will reach out to you.

Please allow 24 hours response via this form. If your request is more urgent please call us at: (403) 212-6099.

Registration

First Name*




Last Name*




Email*




Phone*




Clinic Location*




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