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Schedule an Appointment

To request an appointment please fill out the information below and click the send button. If your request is received by 3:00 PM we will try to reach you the same day. Otherwise we will contact you the next business day. You may also fax (503-598-0755) your request or call (503-598-9302) us during business hours for immediate response.

First Name:
Last Name:

Phone:
- -

Date: (ie. Oct 10)
E-mail:
Time: (ie. 2pm)

Questions/Comments:

Personal Health History

In order to allow us to prepare for your first visit, you can fill out your "Health History Form". Present the completed form on your first visit. This will provide us with the necessary information to better serve your health care needs. Do the following:

  1. Download the pdf files: Click Here for Health History Form
    If your machine says it can't read the file or that you need Acrobat Reader to view the document, Click Here to download Adobe Acrobat Reader.
  2. Print out the seven page forms and fill them out.
  3. Remember to bring the forms on your first visit to expedite your treatment.

 


Scott M Bernhard, DC | 10895 SW Tigard Street
Phone: (503) 598 - 9302 | Fax: (503) 598-0755 | Email: backdoc@spiretech.com

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