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Consultation Request

Please contact our office by phone or complete our appointment request form below. Our scheduling coordinator will contact you to confirm your appointment with Dr. Cox.

Please do not use this form to cancel or change an existing appointments.


Items in bold are required.
Name:  
Address:
City:
State/Province:
Zip/Postal:
Phone:
Email:
Are you a current patient?
Best time(s) to call?
Preferred day(s) of the week for an appointment?
Preferred time(s) for an appointment?
Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.

 


Oral & Maxillofacial Surgery
Mark Cox, DMD - Board Certified Oral Surgeon
2945 Northwoods Way
Redding, CA 96002 - 2136
Phone: (530) 221-6900
*Serving Redding CA 96001 96002 96003 96049 & 96099