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Appointment Reschedule
Patient Name
(Required)
Patient Date of Birth
(Required)
Month
Day
Year
Patient Phone Number
(Required)
Is this a cell phone?
Yes
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Privacy
Email (appointment details will be sent to this email)
(Required)
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.
Date of appointment you wish to change:
(Required)
MM slash DD slash YYYY
Select one Option:
(Required)
I would like to reschedule my appointment
I would like to reschedule my CT Scan
Appointment Day/Time Selection
(Required)
First Available
Monday
Tuesday
Wednesday
Thursday
Friday
1st choice of day (may select more than one)
Preferred time on Monday
(Required)
Morning
Afternoon
No preference
Preferred time on Tuesday
(Required)
Morning
Afternoon
No preference
Preferred time on Wednesday
(Required)
Morning
Afternoon
No preference
Preferred time on Thursday
(Required)
Morning
Afternoon
No preference
Preferred time on Friday
(Required)
Morning
Afternoon
No preference
CT Scans are only performed on Wednesday
(Required)
Wednesday morning
Wednesday afternoon
no preference
Additional information for the scheduling staff:
Please DO NOT include any specific medical information here. If you have an urgent need, please call 541-779-7331.
