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Request an Appointment | (864) 601-9899 | Patient Registration | Office Hours

Monday:7:30 am - 5:00 pm Tuesday:7:30 am - 5:00 pm Wednesday:7:30 am - 5:00 pm Thursday:7:30 am - 5:00 pm Friday:Closed Saturday:Closed Sunday:Closed

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Posted on October 10, 2017 by pcmadmin

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Request an Appointment

New Patients: get your exam, x-rays & cleaning for only $150

($100 for children 12 and under)

Name

Phone

Email

Date of Birth

MM slash DD slash YYYY

Do you have dental insurance?

Yes

No

Insurance Company Name

Subscriber Name

Member/Subscriber ID

Subscriber Date of Birth

MM slash DD slash YYYY

Preferred Time of Day

(Select all that apply)

Early Morning

Late Morning

Early Afternoon

Late Afternoon

What would you like to have done at this appointment?

When was your last dental checkup?

Additional Comments

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.

Request an Appointment

Name

Phone

Email

Date of Birth

MM slash DD slash YYYY

Do you have dental insurance?

Yes

No

Insurance Company Name

Subscriber Name

Member/Subscriber ID

Subscriber Date of Birth

MM slash DD slash YYYY

Preferred Time of Day

(Select all that apply)

Early Morning

Late Morning

Early Afternoon

Late Afternoon

What would you like to have done at this appointment?

When was your last dental checkup?

Additional Comments

CAPTCHA

Email

This field is for validation purposes and should be left unchanged.

Home | About Us | Services | Contact Us

Fountain Inn Dental

1125 North Main St., Fountain Inn, SC 29644 (864) 601-9899

Office Hours

Monday:7:30 am - 5:00 pm Tuesday:7:30 am - 5:00 pm Wednesday:7:30 am - 5:00 pm Thursday:7:30 am - 5:00 pm Friday:Closed Saturday:Closed Sunday:Closed