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Forms

Please download and complete forms as requested by our staff.

Please fill this form if you are 18 years and older.

Adult Health History Form

Please complete this form for your child (<18 years)

Child Health History Form

COVID-19 Attestation

Please fill this form prior to your appointment. If you require assistance with this form, please arrive 20mins before your scheduled appointment, and our staff can help you fill it out.

Registration Form

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    Contact us

    Contact us

    Located in Suite 109 of the Belgage Medical Arts Building.

    Directions

    Contact

    Suite 109 – 525 Belmont Ave W,
    Kitchener ON

    Email: contact[at]chameleondental.ca

    Hours

    Mon. – Wed. 8 am-4 pm
    Thu. 8 am – 1 pm
    Closed for statutory holidays
    Schedule is subject to change.

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