Appointment Request

The first step toward a healthier mouth is to schedule an appointment. Please contact our office by phone/email or complete the appointment request form below. 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.
Are you a current patient?


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: By providing my phone number, I consent to receive SMS text messages from Central Oregon Perio for appointment reminders, marketing messages, and general two-way communication. Msg frequency varies. Msg & data rates may apply. Reply HELP for support. Reply STOP to opt out. Consumer information is not shared with third parties for marketing purposes.

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