New Patient Registration Forms
(These forms need to be printed and brought with you to your appointment)

Health History and Registration Form

HIPPA Acknowledge Form

Insurance/ Payment Authorization Form

Authorization Form for Release of Records

(This form is for any new patient that needs to have their records sent to our office from their previous dentist OR for any current patients that are transferring to another dentist)

HIPPA Notice of Privacy Practices
(These forms DO NOT need to be printed and brought to your appointment)
Call to Schedule an Appointment.
Walk-in appointments are not accepted. Patients are seen by appointment only.
We do not accept children under the age of 16.

18 Office Park Court

Columbia, SC 29223

Tel: (803)788-7300

Fax: (803)788-0942