Online Patient Appointment Request Form

Don’t want to wait on hold to schedule an appointment? Submit this form and we’ll call YOU!

This form is not for urgent requests. For urgent appointment requests, patients need to call 503.552.1551.

*Indicates required.

Name*

Email*

Phone*

Health Center Location
The following partners are unable to support online appointment requests at this time: AHSC, InAct and Pacific Psychology.

Are you a new or existing patient?
NewExisting

Which day is the best to reach you? Select all that apply.
MonTueWedThuFri

When is the best time to reach you? Select all that apply.
8–10a10a–NoonNoon–2p2–5p