Like PDX Center for Dentistry on Facebook Review PDX Center for Dentistry on Google Follow PDX Center for Dentistry on Twitter
Convieniently
Located in Portland's
Pearl District

(503) 928-5903
511 SW 10th Ave Suite 1101
Portland, OR 97205
PDX Center for Dentistry
View and complete PDX Center for Dentistry's new patient forms
Check Out Our New Location
511 SW 10th Ave, Suite 1101
Portland, OR 97205

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.

 


Samuel Seo, DMD

PDX Center for Dentistry


(503) 928-5903
511 SW 10th Ave Suite 1101
Portland, OR 97205
office@sundbergdentistry.com

Like PDX Center for Dentistry on Facebook Review PDX Center for Dentistry on Google Follow PDX Center for Dentistry on Twitter

PDX Center for Dentistry | www.pdxdentistry.com | (503) 928-5903
511 SW 10th Ave, Suite 1101, Portland, OR 97205
Copyright © 2016-2019 PDX Center for Dentistry and WEO MEDIA. All rights reserved.  Sitemap | Links