Current Patients

Photo of girl in dental chair

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:

New Patient Online Forms

Other Forms

Parent/Guardian Consent Form

Patient Info and Release Authorization

Consent for Use of Photos

Check In Form

Frenectomy Infant History Form

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.