New Patient Dental Online Forms

Fill out the necessary dental forms before you visit our office in Chino Hills.

Is this your First-time visiting but hate paperwork? No problem! Complete the necessary patient forms before you come in using our secure online registration system.

Complete your information in 5 easy steps:

1. Go to the link below which will take you to the Secure Dental Online Patient Form
2. Use your email or phone number to authenticate your identity. A 4 digit code will be texted/emailed to you which needs to be entered in the box.
3. You will be taken to our forms page. Complete every page of the forms. You may skip the insurance information ONLY if you have already provided it to the office over the phone or in person.
4. Once you have completed the forms, hit the submit button on the last tab and your information will be securely transmitted to our system.
5. On the day of your dental appointment, sign all the documents and consent patient forms on a digital pad.

You’re done!

Got Questions?

Please click the button to proceed to the encrypted Dental Online Form:

For more information on any procedure about patient forms or to set up an appointment, contact at (909) 679-3447 or Book an appointment.