Request an Appointment

To schedule an appointment with Dr. Brian Cox Dentistry, complete the form below and our scheduling coordinator will reach out to you to confirm the date, time, and details of your appointment. Please note: this form is only for requesting an appointment.

If you need to cancel or reschedule an existing appointment, or if you need immediate assistance, please give us a call at 970.484.3959.

Name of Patient*
First Last
Phone Number (XXX) XXX-XXXX*
Email Address*
Requested Appointment Date
MM slash DD slash YYYY

Our Scheduling Coordinator will follow up either by phone or email with available times or alternate dates.
Reason for Your Visit?
Please Tell Us How You Found Us
Notes for Dentist