Current Patients
Make a payment
Log in to your account
Patient Survey/Feedback
New Patient Registration
Our New Patient Forms are now available online in a digital format so you can complete them at your leisure-saving you time waiting in our office and giving you time to carefully review our policies and procedures. Click on the links below to complete our forms.
New patients, please start here:
Other Forms
Patient Info and Release Authorization
Referring Doctors
Click to download and print a patient referral form.
Helpful Links
American Dental Association
Academy of General Dentistry
Dental Health Online
American Academy of Pediatric Dentistry
West Virginia Dental Association
Translation Services
Charleston Pediatric Dentistry complies with the applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
