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!
Hours
Monday - Thursday
8:00am - 5:00pm
Summer Hours:
7:30am - 2:30pm