Migraine Questionnaire

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- Calgary South Pharmacy
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Learn if you would qualify to receive Botox® for migraines

First Name

Last Name

Phone

Select Your Preferred Location

Do you get 15 or more headaches a month? *

Yes

Would you consider 8 or more of those days to be associated with a migraine? *

Yes

Do your migraines or headaches last more than 4 hours? *

Yes

Do you currently take medication to acutely treat migraines? *

Yes

If you take medication do you find that it successfully ends the migraine? Or would you still consider yourself to be burdened by a migraine or other symptoms that day? *

Yes

Thank you! Someone from our team will be in touch soon.

CONTACT

Edmonton

P: 780-800-5219
F: 587-650-5742

E: hello@uprx.ca

ADDRESS

103, 5083 Windermere Blvd SW
Edmonton, Alberta T6W 0J5

Calgary

P: 587-441-5858
F: 587-441-5859

E: helloyyc@uprx.ca

10201 Southport Road SW Unit 230, Calgary, AB T2W 4X9

HOURS

Edmonton Location

Monday to Friday: 8am-7pm
Saturday: 10am-4pm

Sunday: Closed

Calgary Location

Monday to Thursday: 8am-6pm
Friday: 8am-5pm
Saturday: 9am-3pm

Sunday: Closed

UPharmacy | Pharmacy Licensee/Manager: Ahmad Chehade #13490 | Pharmacy License: 3805

UPharmacy Calgary South | Pharmacy Licensee/Manager: Adam Chehade | Pharmacy License: 4552

Click here to go to the Alberta College of Pharmacists website to view the Patient Concerns poster.

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