Thank you for your willingness to assist with the Calgary Zone Physician response to COVID-19.


Please answer the questions below and submit the form using the button at the bottom.


First Name *
Last Name *
Email *
Phone *
Availability
Do you currently hold an active appointment with AHS
Yes
No
Unsure
A number of services have expressed a potential need for assistance from physician colleagues to manage surge response to COVID-19. Indicate below which areas you are comfortable in assisting.
Please note the needs of the Zone are likely to change over time, the list below is not inclusive of all zone needs nor a determination of preference.

Note: Physicians volunteering to work with COVID patients will be teamed with specialists who traditionally support the key services involved;
  • with non-vented COVID inpatients volunteers will be teamed with a lead from Acute Care Medicine
  • in critical care, volunteers will work in teams led by an ICU attending or anesthesiologists
  • Pre-training to orient volunteers is available to ensure MD safety, knowledge of acute care logistics, and COVID specific clinical care

  • Please select all areas of clinical support.
Service Area ICU/Critical Care
Inpatient/Acute Care
Community Care
Seniors Facility Care
Palliative Care
Urgent Care
Other
License
CPSA - Independent Practice - General Register
CPSA - Supervised Practice - Provisional/Learner
I do not have a license with the CPSA
Comments / Questions
The information submitted on this form is voluntary.

It will only be used to assist with physician resourcing for the COVID-19 response in the Calgary Zone.