Siksika Health Services Staff Contact Information Form

May 23, 2023

This form is for Siksika Health Services staff. Please complete the form below to request a staff ID card, business cards, or to update your contact information. Note: business cards and replacement ID cards are at the expense of each department; please contact your Manager before making a request for these items. Thank you!

Siksika Health Services Staff Contact Information

This form is for Siksika Health Services staff. Please complete the form below to request a staff ID card, business cards, or to update your contact information. Note: business cards and replacement ID cards are at the expense of each department; please contact your Manager before making a request for these items. Thank you!

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

Blackfoot / Traditional Indigenous Name

Post-Nominal Initials (i.e. "RN")

Job Title(Required)

Department (i.e. "Community Health" or "Home Care")(Required)

Work Email Address(Required)

Work Phone Number (Office)(Required)

Work Phone Number (Mobile)

Work Fax Number

I am requesting:(Required)

Please note that business cards are ordered for staff at the discretion of Team Leaders, and paid for by respective departments.

Business Cards

ID Card

Upload Headshot Photo (shoulders-up, plain-coloured background, directly facing the camera, no filters added)

Max. file size: 128 MB.