Call us for your dental emergency today!

 

Telephone: 843-554-4545

                                        843-559-7867

                        1224 Yeamans Hall Road

                         Hanahan, SC 29410

Patient Forms

New patient? Please download and fill out the following forms when you come in for your first appointment.

Patient Medical History Form

This form is mandatory for new patients. To expedite your visit, print this form, fill it out and bring it with you for your first visit.

Consent-HIPAA Form
CONSENT-HIPAA.FORM.pdf
Adobe Acrobat document [6.5 KB]

Patient Registration Form

This form is mandatory for new patients. To expedite your visit, print this form, fill it out and bring it with you for your first visit.

Patient Registration Form
PATIENT REGISTRATION FORMDATE.pdf
Adobe Acrobat document [102.3 KB]

Financial Policy Form

This form is mandatory for new patients. To expedite your visit, print this form, fill it out and bring it with you for your first visit.

Financial Policy Form
FINANCIAL-POLICY2008.pdf
Adobe Acrobat document [108.2 KB]

Call Today!

Mon-Wed :

09:00 am - 05:00 pm

By appointment only only Thursday

Call us at: 1-843-554-4545

1224 Yeamans Hall Road

Hanahan,  SC 29410

Email: jbpallesdmd@knology.net

 

Emergency care

Outside our regular business hours, please note our emergency care information.

Keep Your Teeth Healthy!

What is the best preventive care for your teeth? Find out how to make your next visit easier and more pleasant.

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