Referrals and Forms

***COVID-19 Update:

For the safety of our staff, and our patients, we are offering telemedicine consults for the time being. When you book your appointment, you will be offered a phone consultation, or a videoconference consultation if you prefer. This will enable us to meet your healthcare needs in the safest way possible. Thank you for your understanding while we navigate this together!

Referral criteria

Dr Marsha Kucera is practicing at Calgary MRC and Care and Cure Medical Clinic as a consultant, and requires a referral from your family physician

If you or your patient require more assistance with managing their chronic diseases including metabolic syndrome, diabetes, obesity, overweight, or are at increased risk of these conditions secondary to current lifestyle or family history, Dr. Kucera is able to provide care for these specific issues. Our clinic will also provide specialized care for associated conditions, such as anxiety, depression, and sleep apnea, but we ask that your patient maintain their relationship with their current patient medical home while receiving support from our clinic. We would gladly work together with you as a team!

Referral Forms

Please see the attached referral forms, or feel free to fax your own to Care and Cure Medical Clinic 403-454-2273

To help support the referral process, we have designed an MD referral template to get you started. To refer, you’ll need an active PRAC-ID in Alberta.

New Patient Intake Forms

Please see the attached New Patient Intake Forms and have your patients fill these out prior to seeing our team to facilitate the appointment.

Physician Referral Form

Feel free to use our referral form to facilitate referrals, or you can use your own.

New Patient Intake Form

Our office will have the patients fill out these forms prior to their appointment. To facilitate this process, feel free to share these with your patients prior to their appointments.

NEW - ELECTRONIC PDF FORMS - Rather than printing out the forms above, you can use these electronic forms below to facilitate filling them out on your electronic device. You can send your completed electronic forms to drkucera@calgarymrc.ca

** The electronic PDF form will open in a new window in your browser, but you will likely need to download it and save it locally on your device for it to save your written entries. ***