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Appointment Request

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 nonemergency requests. *If you are experiencing an emergency, please proceed to the closest emergency room or dial 911.
I understand that Oregon ENT Center will use the information provided to schedule appointments and may contact me with the information provided.(Required)

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.

The appointment request form typically takes less than 3 minutes to complete.

If you have questions for your provider that are not scheduling related, please use our Patient Portal or call the office 541-779-7331.

Is this a cell phone number?
I agree to receive text messages at the number provided from Oregon ENT regarding appointments. Message frequency may vary. Message and data rates may apply. Text HELP for help and STOP to opt out. Privacy Policy and Mobile Terms of Service can be found here Privacy
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?
By providing your cell number, you consent to receive informational SMS messages from Oregon ENT. Message and data rates may apply. You may unsubscribe any time by replying STOP to any message.
Have you had an appointment with an Oregon ENT provider in the past three years?(Required)
Patient Mailing Address(Required)
Insurance Information(Required)
Would you like to upload a copy of your card(s) (front and back) or enter the information manually?
Drop files here or
Max. file size: 256 MB, Max. files: 4.
    Insurance Information(Required)
    Are you the primary policy holder?(Required)
    Primary Policy Holder Information(Required)
    Do you have a secondary Insurance Policy?(Required)
    Secondary Insurance Information(Required)
    Is this visit related to a work injury, motor vehicle accident, or personal injury?(Required)
    Do you have a Primary Care provider?(Required)
    Provider Information(Required)
    Please provide your pharmacy information
    Please select the primary reason you are being seen. Please select one from the drop down list
    When did your hearing loss start?(Required)
    Is the hearing loss in:(Required)
    Please check any recent testing related to this condition not performed at Oregon ENT (optional):
    Please note where the CT was done so we may request results
    Please note where the MRI was done so we may request results
    Please note where the Xray was done so we may request results
    Please note where the Ultrasound was done so we may request results
    Please note where the Sleep Study was done so we may request results
    Please note where the Swallowing Study was done so we may request results
    Please note where the Allergy test was done so we may request results
    Please note where the Hearing Test was done so we may request results
    Please note where the Lab Blood Test was done so we may request results
    Please note where the Culture was done so we may request results
    Please note where the Pathology was done so we may request results
    Appointment Day/Time Selection (may select more than one)(Required)
    Preferred time on Monday(Required)
    Preferred time on Tuesday(Required)
    Preferred time on Wednesday(Required)
    Preferred time on Thursday(Required)
    Preferred time on Friday(Required)
    CT Appointment Time Selection(Required)
    CT Scans are only performed on Wednesday