Sheena K. Kansal, DDS Natasha Bramley, DMD
3839 NE Tillamook Street Portland, Oregon 97212 503.288.5891
Appointment Request for:
Name of Patient:
Reason for Appointment:
New Patient Cleaning and X-Ray Toothache or Other Emergency Recommended Treatment Other
Enter a date for your requested appointment: Monday Tuesday Wednesday Thursday Friday
Monday Tuesday Wednesday Thursday Friday
Please type "123" in the box below to validate your submission.