Booking a Dental Screening appointment with Region of Waterloo Public Health and Paramedic Services

Booking a Dental Screening appointment with Region of Waterloo Public Health and Paramedic Services

(Thank you for your interest in booking a Dental Screening appointment with Region of Waterloo Public Health and Paramedic Services. The information that you share below will be shared with registered Dental Hygienist and Dental Assistants from Region of Waterloo Public Health and Paramedic Services and will also be visible to the EarlyON professionals supporting our booking process. We treat all confidential information with the utmost respect and your information will not be shared beyond with those professionals who require it to support your family and your screening appointment.)
This Dental Screening appointment must be made and attended by the child’s parent or legal guardian. If you would like to book an appointment for more than one child, please submit the form separately. Once you have registered for a specific timeslot, please ensure that your KEyON notifications are turned on. Please complete the form below and our EarlyON team will follow up with you with additional information to complete your registration. For more information please visit https://www.regionofwaterloo.ca/en/health-and-wellness/dental-health.aspx#Dental-screening-for-children.
1. Parent/Legal Guardian Name*

First NameLast Name
2. Phone Number*
Please enter a valid phone number.
3. Email Address *
example@example.com
4. Child Name*

First NameLast Name
5. Child's Date of Birth*

MonthDayYear
6. I am the parent or legal guardian of the child and will attend the appointment.*

YesNo
If you answered "no" to the above question, you cannot book this screening appointment. You must be a parent or legal guardian of the child listed in question 4 above.
7. I consent to share my registration information with Region of Waterloo Public Health and Paramedic Services Dental Screening Team.*

YesNo
If you answered "no" to the above question, we are sorry we cannot help you book this dental screening appointment.
8. Which EarlyON location you would like to book to attend?*
9. Which date you would like to book? (Please choose one only)*
9. Which date you would like to book? (Please choose one only)*
9. Which date you would like to book? (Please choose one only)*
We encourage you to arrive early for your appointment to sign into the EarlyON location.
Should be Empty: