Patient Registration Forms

Save time on your next visit.

Complete your patient registration paperwork online, or print the form and bring it to your next appointment. If you have any questions, please call our office during regular business hours.

Submit your paperwork online

Having Trouble?

If you have any trouble with the form above, please try one of these links instead:

What is “Adobe Sign®”?

Adobe Sign® is certified compliant with ISO 27001, SOC 2 Type 2, and PCI DSS. To learn more, please visit the Adobe Sign Trust Center, or visit the Adobe Sign FAQ page.

COVID-19 Update

Dear Patient,

Due to the recent surge in COVID-19 cases in the Inland Empire and surrounding counties, our dental offices have decided to temporarily discontinue all routine dental care and preventive services until January 8th, 2021. This is for your safety and to help slow the spread of COVID-19.

Though we are closed for routine dentistry we are here for you and your family. If you are experiencing dental pain, discomfort, or any other dental emergency, please give us a call at 909-307-6453. We will return your call and assist you as soon as possible.

Thank you for your time and understanding as we work together to care for all our friends, family, and loved ones during this difficult time.


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