New Patient Forms

If you are a new patient to our office, we will need you to fill out a medical history form and a patient registration form when you arrive. If you would like to save time at the office, please feel free to fill out the forms using the buttons below. Thank you!

Acknowledgement of Receipt of Notice of Privacy Practices 
Authorization for Release of Information   
Financial Policy
Health History
Insurance Information
Minor Authorization
Patient Information
Recare Patient Update Form

Contact Us

Lake Wylie Pediatric Dentistry
534 Nautical Drive
Lake Wylie, SC 29710

Phone: 803-619-5155
Email Us!


Monday - Thursday
8:00am - 5:00pm

Summer Hours:
7:30am - 2:30pm