Confirmation of Mammography Room Shielding

  • Signature

  • This is the email address we will send a submission confirmation notification to.
  • Date Format: MM slash DD slash YYYY
  • Your privacy is important to us! We collect, use and/or disclose your personal information with your consent unless otherwise authorized or required by legislation. As per our CPSA Privacy Statement, we collect and use your personal information to do our CPSA work, which is to protect Albertans and to guide and regulate Alberta physicians.