Appointments

Our scheduling team is ready to help you schedule an appointment with one of our specialists.
Call 541-322-2352, Monday – Friday, 8:00 a.m. – 5:00 p.m.

To request an appointment online please complete the following form and a team member will contact you. We use this information to set up your registration and schedule your appointment appropriately. Any information obtained will be kept confidential.


Patient Information

 New Patient Current Patient

First Name (required)

Middle Initial

Last Name (required)

Suffix

(example: Jr.)

Street Address

City, State, ZIP

(example: Bend, OR 97701)

Birthdate

(mm/dd/yyyy)

Contact Phone:
(example: 555-555-5555, area code required)

Can we leave a message at this phone?
 Yes No

Your Email (required)

Describe Injury or Condition

Indicate Side  Left Right

Referred by:
(Physician Name)

Which Center physician would you prefer seeing?

Do you have insurance you would like us to bill?
 Yes No

Insurance Name

Please answer correctly:
1+1=?