Mauldin Family Dentistry
Dr. Daniel J. Halasz
Creating Beautiful Smiles


The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.

Please note that this appointment request form is used to schedule regular, preventative maintenance appointments and appointment requests for new patients.  Please do not use this form to cancel or change an existing appointment, or in the case of dental emergency situations.  If your appointment request involves a dental emergency, please contact us at our office phone, 864-288-9780, to ensure that you are seen in a timely manner.  Thank you.
*Items in bold are required.
Are you a current patient?

Preferred day(s) of the week for an appointment?

Preferred time(s) for an appointment?

Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information. 


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