Select the Form for Your Child
Use this form if your child is new to Connect the Dots, or if it has been a year or more since your child has been seen by us.
Use this form if your child has been seen by Connect the Dots in the last year.
Eugene Clinic:
84 Centennial Loop
Eugene, OR 97401
Phone: (541) 255-2681
Fax: (541) 255-3537
Clinic Hours:
8:00 to 6:00 Monday – Thursday
8:00 to 5:00 Friday
Corvallis Clinic:
201 NW 3rd St.
Corvallis, OR 97330
Phone: (541) 255-2681
Fax: (541) 255-3537
Clinic Hours:
8:00 to 6:00 Monday - Thursday
8:00 to 5:00 Friday