Appointment Use the form below to send an appointment request to our office or call us at (803) 324 – 7670. We will contact you back as soon as possible to verify your appointment. Appointment Form Patient First Name * Patient Last Name * Parent name, if patient is under 18 years of age. Parent First Name Parent Last Name Email Address * Daytime Phone * Alternative Phone Choose Preferred Time for Appointment Early Morning Late Morning Noon Early Afternoon Late Afternoon How did you hear about our practice? * Google Print Ad Billboard Referral Other Message * Send Message If you are human, leave this field blank.