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225 Broad Street
Bennettsville, SC 29512

Patient Forms

Our new patient forms are availabe below. Please feel free to download, print, and fill out these forms prior to your first appointment. Doing so will enable us to begin your appointment as soon as possible.

Welcome to our practice
Health
History
HIPAA – sign and return to us
HIPAA – You Keep

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Appointment Request

The first step towards a beautiful, healthy smile is to schedule an appointment.
You can call us at: (843) 479-0305 or complete the appointment request form below.

Our scheduling coordinator will contact you to confirm your appointment. Please do not use this form to cancel or change an existing appointment. *Items with an asterisk are required.

Appointment Form

Mon 8:30 – 5:00
Tue 8:30 – 5:00
Wed 8:30 – 5:00
Thur 8:30 – 12:00
Fri 8:30 – 5:00
Explore our remarkable offers for new patients