Shine Dentistry 9625 Monte Vista Ave., Suite 104
Montclair, CA 91763
(909) 624-7222
Patient Referrals
The form below will send an email to your friend. We will only contact them if they respond saying that they would like more information about our office.
*Friend's first name:
*Friend's last name:
Friend's phone number:
*Friend's email address:
*Your first name:
*Your last name:
*Your email address:
 
Notes:
* Required field      
Patient Resources

New Patient Referral Program
One of the highest compliments a dental practice can receive is when a patient refers a friend, co-worker or relative. We have made this process simple and easy. Use in the form to the right. We guarantee they will receive the same high standard quality of care you have already come to expect from us.

Current Patients
Click below to log in to your account. Once logged in you can check your appointments, make payments online, etc.

New Patients
Our New Patient Forms are now available online so you can complete them at your leisure – saving you time waiting in our office and giving you time to carefully review our policies and procedures. Click on the link below to fill out and submit your form directly to the doctor. No downloading, printing, or writing.

Helpful Links
American Dental Association - www.ada.org | Academy of General Dentistry - www.agd.org