.....
...... ..
....
Schedule an appointment

Fill out the form below or call the office to make an appointment. If this will be your first appointment, you may need to also fill out some forms from the Forms page and fax them into the office.

Phone: (541)-686-2931
Fax: (541)-686-4500

*First Name:
*Last Name:
*Daytime Phone:
*Evening Phone:
Address 1:
Address 2:
City:
 State:
Zipcode:
 *E-Mail:
*Prefered Appointment Dates:
*Prefered Appointment Times:
Comments:



Link to American Dental Association ............. Link to American Academy of Implant Dentistry ............. Link to Academy of General Dentistry ............. Link to Lane County Dental Society
Copyright © 2000-2002 Shane Samy, D.M.C., P.C.
All rights reserved