Please select type of telephone communication.
Note: By providing your cellular phone number, you consent to receive SMS text messages from Cook Dentistry Mason for appointment reminders, marketing messages, and general communication. Message frequency may vary depending on the type of communication. Standard message and data rates may apply, as determined by my mobile carrier. I understand that I can reply with “HELP” for support or “STOP” to opt out of receiving future messages at any time. See our Privacy Policy for further information.
Check if you currently have or have had any of the following:
To the best of my knowledge, the above information is complete and correct. I understand that it is my responsibility to inform my Doctor if I, or my minor child, ever have a change in health.