Patient Registration

New Patient Forms

We are glad that you are interested in becoming a patient of Dr. Wilkerson’s dental practice. New patients are always welcome here. Everyone at Children's Dentistry is committed to making your visits pleasant and stress-free. You can count on our friendly, highly experienced staff to always provide the highest standard of dental care in a clean, state-of-the art environment. Your comfort is our top priority.

Below are forms that may be helpful to complete prior to your first visit or as necessary. Please call our office for assistance: Pediatric Dental Office in Charleston WV Phone Number 304-345-0541

Patient Information & Medical History Forms:  https://forms.patientconnect365.com/7052

• Referral Form
• Consent Form
• Patient Questionnaire
• Records Release Form

Technical Note

If you are having trouble accessing our Patient Registration forms, then please download Adobe Reader to view and print the forms from home!