Country Hills Dentistry

Patient Information

As patients of Country Hills Dentistry we want to make your appointment as easy as possible. Read our patient forms and policies for more information about your next visit. 

Patient Policies and Forms

Cancellation Appointments are scheduled specifically for you. Our team will contact each of our patients one week prior and again one day prior to a scheduled appointment with a courtesy reminder. However, it is each patient’s ultimate responsibility to arrive for the scheduled appointment.

We require a minimum of 2 full business days’ notice to change and/or cancel appointments. If an appointment is missed, a fee of $75 will apply.


It is the patient's responsibility to pay the fees for their dental procedures.

We accept the following methods of payment: 

  • Mastercard
  • Visa
  • Debit
  • Cash

Dental Insurance

Dental insurance is a contract between the patient, their employer and their insurance company. We are here to assist you with calls to your insurance company, in your presence, to determine eligibility and coverage, and to assist with predeterminations as well. We believe an informed patient will utilize their dental benefits, which maximizes their overall health.

Flexible Financing

We understand that dental treatments can sometimes be costly. We want to help you avoid this obstacle to maintaining good oral health. Our practice offers different payment options to meet your needs.

Patient Form

For your convenience, please download and complete the attached new patient form and bring it with you to your initial appointment. If you have any questions about the form, or any other dental concerns, feel free to contact our team at Country Hills Dental and they would be happy to help.

New Patient Form | Download

Privacy Policy

The Personal Health Information Protection Act, 2004 (PHIPA) came into effect on November 1, 2004, and governs the collection, use, and disclosure of Personal Health Information within Ontario’s health care system, and the Personal Information Protection and Electronic Documents Act, which came into effect in 2001, governs Personal Information other than Personal Health Information. Read the overview of our Privacy and Anti-Spam Code. 

Privacy Policy Ontario | Download

Contact Country Hills Dentistry in South West Kitchener today!