New patients receive Free in Office Whitening with a new patient exam.

Sign-up using the form or call us at (519) 578-2419 to take advantage of this exclusive offer.

New Patient Forms

New Patient Forms and Online Forms

forms

Kitchener East Family Dental offers our patient form(s) online so they can be completed it in the convenience of your own home or office. Follow these easy three steps:

  • If you do not already have AdobeReaderĀ® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Bring them with you to your appointment.

New Dental Patient Form - Required

This lets us know the history and current state of your dental health. What questions, concerns, goals, regarding dental care can we help you with? Let us know!

Download Fillable PDF & Email Us Completed Form

Release of Records Form - Required

Download Fillable PDF & Email Us Completed Form

Once you have completed our online fillable PDFs, please email us the completed form prior to coming in. Email Us Here

Download the Free AdobeReaderĀ®

Contact Us!

Send us an Email!

Our Location

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Hours of Operation

Our Regular Schedule

Kitchener East Family Dental

Monday:

8:30 am-6:30 pm

Tuesday:

8:30 am-6:30 pm

Wednesday:

8:30 am-6:30 pm

Thursday:

8:30 am-6:30 pm

Friday:

8:30 am-4:00 pm

Saturday:

9:00 am to 3:00pm First & Third Saturdays every month

Sunday:

Closed