Appointment

In an effort to make your visit run smoothly, please print and fill-out the Health History Form below. Thank you!

Use the form below to send an appointment request to our office or call us at (864) 582-2371. We will contact you as soon as possible to verify your appointment.

Patient Name*
First Last
Patient Name
First Last

if patient is under 18 years of age
Email*
Daytime Phone*
Alternative Phone
Preferred Day*
Preferred Time

: HH

MM
How did you hear about our practice?
How did you hear about our website?
Tell us about your dental needs*
Captcha