Request an Appointment

Please do not use this form if you have an urgent problem or need to reschedule an existing appointment. Instead, contact our office at (541) 689-1645. After you submit your request, our appointment scheduler will respond within 48 hours. See below for forms to complete.

Patient Registration Forms

360 Dental in Eugene, Oregon welcomes you to our practice. Once you have made your initial appointment, you may pre-register by downloading, printing, and completing the forms below. Completing the forms prior to your visit will help speed up the new patient registration process.

Downloadable Forms:

• New Patient Registration
• Health History

Please note: It may take a few minutes to load the forms if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat for free by clicking on the icon below.