Your First Choice for Dental Care in the Chino Hills Area

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) 326-2232!

What's Included with the

Chino Hills Dentistry Experience?
  • Minimally Invasive
    Oral Care

    We perform dental procedures that minimize the risks of surgery while maximizing your comfort.

  • Advocates for
    Preventative Treatment

    We encourage taking preventative dental measures now. It will save you from pricey procedures later!

  • Two Steps Ahead
    of Other Dentistries

    Our offices are equipped with the newest technologies to make your visit as seamless as possible.

  • Accommodating of
    Your Budget

    We accept most insurance providers and offer flexible payment options.