Referrals

Dr. Cox prides herself on close communication with other providers to provide comprehensive, collaborative care for her patients.

After you fill out this referral form, a member of the Reset Health & Wellness team will follow up with you and/or your patient directly.

If able, please fax last clinic note, medication history, and any additional relevant information to 984.205.8519 or email to info@resetyourhealthandwellness.com.

Referring Source | Please include your Name, Agency, Contact Phone Number and/or Email

Patient Name

Patient Email

Subject

Patient Phone Number | Please be sure to notify patient of your referral and indicate that we will call and may leave a generic voicemail for them to return our call.

Patient Date of Birth

Services Requested:

Consultation or 2nd opinion

Medication management

Psychotherapy

Other

If "other" was chosen above, please provide details:

Thanks for submitting!