Due to our concern for patient safety, not ALL appointments can be scheduled on line. Therefore if you are experiencing a MEDICAL EMERGENCY, PLEASE CALL 911. Or if you’re having medical symptoms which are of concern, please call Ventana Wellness at (541) 773-9772 for assistance.
To schedule an Appointment Online, please complete the patient/appointment information below:
Your Information:
*Required Information |
*Name |
|
*Date of birth |
|
*Phone |
|
Alternative phone |
|
*Email address |
|
Doctor/Specialist you want to see |
|
Reason for Appointment |
|
Date: |
*Preferred Time of the day
|
1st choice |
|
2nd choice |
|
*Preferred Day of the week
|
1st choice |
|
2nd choice |
|
|
Newsletter |
|
|
By signing below I agree that I have reviewed and understand the information above and that I have answered all questions honestly and to the best of my knowledge. I also understand that this digital signature will remain on file and will be in place of a physical signature.
*Signature:
|
|
| We will respond to your request within 48 hours, Monday - Friday, 8:30 am - 5:00 pm. If you do not hear from us within that timeframe or you prefer personalized assistance please phone Ventana Wellness at 773-9772. |
| |
|
*APPOINTMENT ONLINE cannot be used to ask for advise regarding a specific health related question, emergency medical conditions, prescription refills, lab requests or if you need to schedule a visit 2 days from today. Those situations should be directed to your Clinic physician by calling (541) 773-9772.
We value your privacy. Your personal information will not be used by us other than to schedule an appointment.
|