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Home - Referrals

Referrals

Please fill the following form to make a referral to our pediatric dentist.

Don’t have a referral? We are more than happy to help you!

Email: contact@chameleondental.ca
Phone: 226.791.9168

MAKE A REFERRAL

Please complete this form to make a referral to our pediatric dentist.

    Referring Office



    Patient Information


    M/D/Y

    If 'Other' was selected, please specify preferred pronouns.






    PanorexPeriapicalsBitewings
    If you are having difficulty attaching x-rays, please email x-rays to referrals@chameleondental.ca and indicate the date taken.


    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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