Request an appointment

Required fields are marked with *. If you have trouble submitting this form, call (541) 779-7331.

Before you begin

Privacy

Our online form is confidential and secure. We value your privacy, and will not sell your email or personal information to any third party. By completing this form you acknowledge that Oregon ENT Center will use this information for scheduling and account creation purposes.

Disclaimer

This system is for non-emergency requests. If you are experiencing an emergency, go to the closest emergency room or dial 911. If you are a post-operative patient and have questions or need a follow-up, call (541) 779-7331.

New patients

For NEW PATIENTS: You will need your insurance information to schedule. If your insurance requires a referral, please confirm that your primary care provider has faxed the referral. This form typically takes less than 3 minutes. If you have questions for your provider that are not scheduling related, use the patient portal or call (541) 779-7331.

Patient

Patient Name

Patient Date of Birth

Patient Gender

How to reach you

Patient Phone Number

Is this a cell phone number?Yes

Email (appointment details will be sent to this email)

By providing your email, you consent to receive informational email messages from Oregon ENT. Message and data rates may apply. You may unsubscribe any time by replying STOP to any message.

Are you making this appointment for someone other than yourself such as a child or dependent?Yes

Visit history

Have you had an appointment with an Oregon ENT provider in the past three years?

YesNo - New Patient

Confidential. Sent directly to the Oregon ENT scheduling team.

1Before you begin

2Patient

3How to reach you

4Visit history

Before you begin

Patient

How to reach you

Visit history