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(843) 479-0305
225 Broad Street
Bennettsville, SC 29512
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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
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Health
History
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HIPAA – sign and return to us
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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

  • OFFICE HOURS
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
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We are a dental practice that takes pride in our ability to restore and enhance the natural beauty of your smile, using only the latest and most conservative technologically advanced procedures. The results of our efforts mean that our patients have beautiful and long-lasting smiles! We treat both the young and the young at heart.

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225 Broad Street, Bennettsville, SC 29512 | Phone: (843) 479-0305 | Site Design and Internet Marketing provided by Dentistidentity.com