Request and Appointment with Sundberg Center for Dentistry View and complete Sundberg Center for Dentistry's new patient forms
(503) 928-5903
222 NW 10th Ave Portland, OR 97209-3109

Appointment Commitment Agreement

We respectfully request a 2-business day notice for cancellations or rescheduling an appointment. This allows enough time to contact our patients waiting for treatment.

 

If you are unable to allow a 2-business day notice, we will notate the account with a Short Notice Cancellation warning. If any additional Short Notice Cancellations occur, we will apply a Cancellation fee to the account. This fee is $75 for Hygiene hour and $150 for a Doctor hour.

 

We are 100% committed to our patients and respectfully request the same in return.

 

Electronic Signature

Patient First Name: *

Patient Last Name: *

Date: *

The person filing out form is: *

If Representative, Representative';s Name:

 
 

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

 
Request Your Viseh Sundberg, DDS
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Refer a friend to Sundberg Center for Dentistry
Viseh Sundberg, DDS

Sundberg Center for Dentistry


(503) 928-5903
222 NW 10th Ave
Portland, OR 97209
office@sundbergdentistry.com
Sundberg Center for Dentistry | www.sundbergdentistry.com | (503) 928-5903
222 NW 10th Ave, Portland, OR 97209
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