Request an Appointment

Please fill out the form below and we will contact you with an appointment time. Required fields are marked with asterisks (*).

Patient Information

Name: *

Phone: *

Email address: *

Have you visited our office before? *

Yes No  

What is the reason for the appointment? *

  Regular Exam / Cleaning
  Specific Concern / Procedure

What concerns, if any, would you like to speak to the doctor about:

Confirmation

How do you prefer to be contacted? *

  Email   Phone  

 
 

It may take a moment to submit your information. Please wait for a confirmation message.

 


Office Hours:

Mon: 8am – 4:30pm
Tue: 8am – 4:30pm
Wed: 8am – 4:30pm
Thu: 7:30am – 3:30pm
Fri: By Appointment


Phone:

(541) 246-3250

Address:

4765 Village Plaza Loop Suite 101
Eugene, OR 97401-6676


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