Contact Us

Request An Appointment

The first step toward your new beautiful, healthy smile is to schedule a COMPLIMENTARY CONSULTATION. Please complete and submit the request form below. If you contact us after hours, we will get back to you the next business day. We look forward to hearing from you!

Please note this form is for requesting an appointment. If you need to cancel or reschedule an existing appointment, or if you require immediate attention, please call our office during normal business hours.

Request An Appointment Form

Patient Name*
First Last
Email*
Daytime Phone*
Mobile Phone
Preferred Days*
Time*

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AM/PM
How did you hear about our practice?*
How did you find our website?
Comments*
Phone
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Schedule an Appointment

(503) 287-9710

Office Hours:

Monday	7:40AM – 5:00PM
Tuesday	7:40AM – 5:00PM
Wednesday	7:40AM – 5:00PM
Thursday	7:40AM – 5:00PM
Friday	Special Appointment Only

Office Address

Address: 4707 NE Tillamook St, Portland, OR 97213

Phone: (503) 287-9710

Fax: (503)281-7098