Clinic Forms (Printable PDF Format)
Patient Info/Health History Form
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Medicare Patient Notice
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HIPPA Notice of Privacy Practices
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SDDC Cancellation-No Show Policy
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General Consent Form
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1-Page HIPPA Notice of Privacy Practices
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At the South Delta Dental Clinic we make beautiful smiles a reality. Quality dental care is provided by a MS state licensed Dentist and our experienced staff at our beautiful office located at the Sharkey-Issaquenna Community Hospital in Rolling Fork, MS. We Provide a wide array of dental procedures including Implant Restorations, Fillings, Crowns, Whitening, Bridges, Smile Makeovers, Veneers, Teeth Whitening, and many other services
