Please contact our Portland or St. Helens Oral Surgery & Implantology office or complete the appointment request form below to schedule your appointment. Our scheduling coordinator will contact you to confirm your appointment.

Please do not use this form to cancel or change an existing appointment.


*Items in bold are required.
Name:  
Address:
City:
State/Province:
Zip/Postal:
Email:
Phone:  
Are you a current patient?
Best time(s) to call?

Which office location(s) would you prefer for your appointment?
Preferred day(s) of the week for an appointment?
Preferred time(s) for an appointment?
Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.