Request an Appointment

Phone

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Patient's First & Last Name:(Required)

Patient's Birthdate: (Required for positive identification)(Required)

Email Address(Required)

Phone Number(Required)

Are you a new or current patient?

What is the purpose of this appointment?

How soon would you like to come in?

Do you prefer a particular day?

Second choice of days

Do you prefer a particular time of day?

Second choice of times

How did you hear about us?

In the space below, please include any additional day, date, and time requirements you may have. If you would like to request an appointment for another family member or more, also include first and last names, plus any time requests for the additional appointment(s).

Comments/Questions

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Request an Appointment

Patrick Sherrard DMD, PC

(503) 246-4712

(503) 730-6523

Office Hours

Why Choose Us?