Patient Forms

The first visit to our office is designed to get you better acquainted with all we offer as well as introduce you to Dr. Dan, Dr. Rebecca,and our caring team. We encourage questions and do our best to always deliver quality care.

Please take a moment prior to your scheduled appointment to download our patient forms. We ask that you complete the forms and bring them with you to your appointment so we may better assist you in a timely manner. Thank you for your confidence in our office, we look forward to assisting you with all your dental needs.

Click the Form below to download

Pt Information

Patient Information and Medical History


Dental History

Dental History


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Destination Dentistry
Dr. Rebecca Kretschmar
At Destination Dentistry, we offer a wide variety of dental services, including cosmetic and family dentistry, as well as sedation dentistry and TMJ treatment. Call us today to schedule an appointment if you are in Custer or Black Hills area.
141 N 5th St
Custer, SD 57730
Call: 605-673-2011605-593-9821
info@destinationdentistry.net
Testimonials
  • …I had no discomfort (with the laser). Yes, an awareness of ’something done’, but no pain what so ever! You did a good job Doc. If anyone wants to ask me, I’ll tell them. It’s time for the old Bard Parker blade to be relegated to the history file. Thank you for your skills.
    —Dr. Art L., M.D.
  • Congratulations on your beautiful Hi-tech office-and on your thirty years of working together! Also you need to know I appreciate the picture you sent me of my teeth. They are absolutely the best pictures I have ever taken. Thank you for the good service you provide.
    —Arlene B.
  • I enjoyed meeting Dr. Rebecca. The information that she shared with me was greatly appreciated. She has a nice confident way about her.
    —Jackie H.
  • Dr. Dan you continue to amaze me-this a great addition (the website) to your already first class operation. I always tell people that I feel so lucky to have such a great dentist who is on the cutting edge of his profession
    —Steve G.
  • Everyone was great as usual….it was great meeting Dr. Rebecca. (my wife’s) term for her was “delightful” and I concur.
    —John C.
  • While vacationing in Custer, SD I cracked a tooth. Dr. Custis repaired it and did excellent work. Wish I could use him as my regular dentist.
    —Jim C.

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