Siksika Health Services Staff Contact Information Form

May 23, 2023

Siksika Health Services Staff Contact Information

Name (first and last names, please)(Required)

Job Title(Required)

Work Email Address(Required)

Work Phone Number (Office)(Required)

Work Phone Number (Mobile)

Work Fax Number

Are there any online forms/resources that you regularly use for internal Siksika Health staff access? (i.e. help desk, comms request form, etc.) If so, please include the link below.

I am requesting:(Required)

Business Cards

ID Card

For staff ID cards: please upload a photo of yourself. Your photo should be similar to a passport photo, but with more smile if you like: taken straight on, including from shoulders up; taken in front of a plain white or off-white background; and refrain from wearing hats or sunglasses.

Max. file size: 2 GB.