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Screening Appointment Request
To schedule an appointment please fill out the information requested below. We will confirm your appointment via your preferred method of contact.

If your desired screening date is unavailable, we may have reached capacity for that screening. Please call our office at 541-383-6357 to confirm.

Screening Date
All dates are Friday unless otherwise noted
Desired Appointment Start Time
Please choose your desired appointment start time. Screening takes 1-2 hours (2 or more children may take longer)
Child First Name
Child First Name
Your answer
Child Last Name
Child Last Name
Your answer
Date of Birth
Your answer
Child Gender
Parent First Name
Your answer
Parent Last Name
Your answer
Home Phone
Your answer
Street Address
Your answer
City and Zip Code
Your answer
Email Address
Your answer
Preferred Method of Contact
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