Client Registration

Online Dental Registration System

Dr. Mercado and her team of dental professionals are dedicated to making your visit as comfortable and efficient as possible. To allow us to get to know you, please pre-register with our office by filling out our online New Patient Registration forms prior to your visit.

Important

If you are unable to complete the forms prior to your reservation, please plan to arrive 15 minutes early, so that your paperwork is completed by the time of your scheduled reservation.

If you have any questions, please do not hesitate to call our office: Fort Mill Office Phone Number 803-547-7779.

Office Hours

Patient Portal and Online Forms

Use our online Patient Portal to fill out New Patient Registration forms.

Use our online Patient Portal to fill out a New Health History form.

Please fill out and complete all forms (see list below) prior to clicking “SUBMIT”. This will allow our secure, HIPAA-compliant software to import the information. You must complete each page before continuing to the next page.

• • Patient Information
  • Health History
  • HIPAA Notification
  • HIPAA Acknowledgement
  • HIPAA Release of Information

Call our office if you have any questions: Fort Mill Office Phone Number 803-547-7779.

On your first visit to our Fort Mill SC dental office, we will have your completed form available for your signature. The security and privacy of your personal data are one of our primary concerns and we have taken every precaution to protect it.