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(503) 765-7300
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Request an Appointment

Please fill out the form below and we will contact you with an appointment time. Required fields are marked with asterisks (*).

Patient Information

Name: *

Phone: *

Email address: *

Have you visited our office before? *

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What is the reason for the appointment? *

  Regular Exam / Cleaning
  Specific Concern / Procedure

What concerns, if any, would you like to speak to the doctor about:

 

Confirmation

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  Email   Phone  

 
 

It may take a moment to submit your information. Please wait for a confirmation message.

 
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Call us today
(503) 765-7300
Fax Us
(503) 697-5999
Nicholas Dose, DMD
601 1st Street Suite A
Lake Oswego, OR 97034-2370
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