📣 Providence Pediatric Cardiology Clinic will open in our new location January 5, 2026, just across the street from our current location! New clinic address: Suite #120, 28 Quarry Pk Blvd SE, Calgary, AB T2C 5P9

Pediatric Cardiology Consultation & Test Request Form

Providence Pediatric Cardiology is proud to be Calgary’s only private pediatric cardiology clinic, serving families across Southern Alberta, Medicine Hat, and parts of British Columbia. Our team of experienced pediatric cardiologists — Dr. Frank Dicke, Dr. Steven Greenway, and Dr. Michael Giuffre — provide specialized care for children with suspected or known heart conditions.

We offer a full range of pediatric cardiology services, including:

  • Pediatric cardiology consultations

  • Echocardiograms (Echo)

  • Electrocardiograms (ECG)

  • Holter monitoring

  • Exercise treadmill testing

Download the Requisition Form

This requisition form is designed for referring physicians and healthcare providers to request a consultation or diagnostic test for their patients.

  • Please complete all patient information, including history, symptoms, and indication for referral.

  • Urgent cases should be directed to the nearest emergency department. For time-sensitive referrals, contact our clinic directly at 403-255-2737.

  • Once completed, the form can be faxed to 403-255-6709 or emailed securely as instructed by your office.