© 2019 Pacific Sports and Interventional Spine, LLC

74B Centennial Loop | Suite 100 | Eugene, Oregon 97401

Tel: 541-780-6654

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How to Become a New Patient

To become a new patient at Pacific Sports & Spine please fill out the  "New Patient Request" form below. Once completed, our new patient coordinator will call you within the next 2-3 business days. Please complete the form as thoroughly as possible to increase the efficiency of the review process.

* If you do not have a primary care physician or referring provider, we will need to schedule you an appointment with one of the physician assistants to assess your condition before submitting it to one of the surgeons for review.

This form may be used to submit your information to schedule an appointment. If you wish to not use this form, Please download the Patient Registration Form and send it to our office.