Patient Forms

If you are a new patient at our dental office in Chino, we want to ensure that your first visit is as efficient as possible. Please complete the attached new patient bundle forms before arriving at our office to expedite check-in and address your medical needs better. Printing the records, filling them out in advance, and bringing them with you, can promptly attend to your dental requirements. If you require any help, please don't hesitate to contact our office.

Patient Forms (Print & Complete All Forms Before First Office Visit)

New Patient Form: This is vital to your dental record. Completing this form provides instructions for new patients. I am providing instructions for new patients and providing education for new patients. And, of time, you enable us to streamline the registration process and ensure we have all the necessary information to provide you with the highest quality of care. By maintaining your Patient form, all your dental information can be accessed accordingly and address your concerns in a timely manner.

HIPAA Form: The Health Insurance Portability and Accountability Act (HIPAA) is designed to protect your privacy and confidentiality. By signing this form, you give us permission to use and disclose your protected health information for treatment purposes while safeguarding your data. We at Chino ensure Patient-Doctor Confidentiality and Integrity, provide high-quality dental care and protect our Patient’s health and well-being.

Our dental practice, led by Dr. Rakesh Patel, greatly emphasizes efficiency and personalized care. By completing these forms in advance, you actively contribute to the smooth running of your visit, allowing us to focus more on addressing your dental needs and concerns. We genuinely appreciate your cooperation in this matter.

Please do not hesitate to contact our office if you have any questions or require further assistance with the patient forms or any other aspect of your dental care. Our friendly and knowledgeable staff are here to provide the support and information you need to have a positive and stress-free dental experience.

We anticipate your arrival at our practice and aim to offer outstanding dental services customized to suit your requirements.