Plastic Surgery Associates of Redding

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Correspond with Plastic Surgery Associates

We invite you to take advantage of the 24-hour 7-day availability of electronic mail to request a brochure, be added to our mailing list or otherwise tell us how we may assist you. This simple fill-in-the-blanks form is designed to make sure we receive adequate information, while making it as easy as possible for you to correspond with us.

Due to patient confidentiality we can not discuss your specific medical condition by email or phone. And due to the variables of electronic mail systems, we can not accept responsibility for any delay in receiving messages. If it is important, or you would like to request an appointment please call us at 241-1300.

Please be assured that any information you may provide will be keep strictly confidential within the PSAR office.

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Daytime phone (w/area code) *		(555)555-5555

Evening phone (w/area code)		(555)555-5555

Your e-mail address

The best date and time for me to come in would be		e.g. 5/1/07 3:00 PM

I'd like to schedule the appointment with	No preference Dr. Ball Dr. Mendez Dr. Wong

If this is for someone else, please provide their name

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May we occasionally send you pertinent information?	By E-mail By Postal Mail No thank you

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If there is some other way we can assist you just tell us here