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Patient Forms

Our Chino Hills Dentist Is Looking Forward to Meeting You


Are you a new patient at Chino Hills Dentistry? If you are, then we highly recommend that you fill out our patient forms online. By filling out your forms even before you come in, you will be able to gather all the necessary information in a relaxed environment, rather than scrambling during the short wait before your visit with Dr. Randy Agnew. We’ll be able to dedicate more time to your dental care and you can be sure the information you’ve provided is complete and accurate. Additionally, with your patient forms completed early, our friendly staff can better help you with filing insurance claims and getting the most out of your coverage.

We advise you to fill out the forms as carefully and honestly as you can so we can make sure that we are providing you with the highest level of dental care possible.

Download Medical History/Registration Form

If you have questions or concerns about the information that you need to provide, please feel free to contact our office at (909) 364-8282!

Our Location

3110 Chino Ave, Suite 260 | Chino Hills, CA 91709

Office Hours

Our General Schedule

Monday:

9:00 am-6:00 pm

Tuesday:

9:00 am-6:00 pm

Wednesday:

9:00 am-6:00 pm

Thursday:

9:00 am-6:00 pm

Friday:

8:00 am-5:00 pm

Saturday:

Closed

Sunday:

Closed

Contact Us Today!

We look forward to hearing from you.