Northwest Sinus Center
2450 NE Mary Rose Pl, Suite 130 Bend, OR 97701
(855) 746-8700
Appointment Request
1. Considering how severe the problem is when you experience it and how frequently it happens, please rate each item below on how “bad” it is by ticking the radio button that corresponds with how you feel.
2. Please mark the most important items affecting your health (maximum of 5 items).