Patient Forms

 
 

We have made our new patient forms available to you in two ways.

   1. You may fill out the forms online by clicking HERE and your chart will be ready when you arrive.

Or:

   

You will need Adobe Acrobat Reader on your computer to download the printable forms.

Please click and print the following forms, fill them out completely, and bring them to your first appointment!

New Patient Account Form

New Patient Health History Form

Welcome Packet
Office Brochure

Financing Options

 

CareCredit Payment Plans Available

 

 

Carolina Smile Center    1701 First Baxter Crossing, Tower Place Suite 102, Fort Mill South Carolina 29708   
Voice (803) 548-6480  Fax (803) 327-3288    Toll Free 1-877-566-4472

©2003 Dr. Jeff T. Blank  ·  Site designed and maintained by TNT Dental