Refer a Friend

 

If you've been a happy patient of Dr. Rick Coker's Smile Studio and would like to refer one of your friends to us, we promise to take very good care of them.  Even if you haven't yet been a patient, we would still love to meet your friends.

If you have suggested to one of your friends or relatives that they make an appointment with our office, send us their name on the form below.  If that person schedules and begins treatment on their smile within 180 days, we would like to send you a gift certificate worth $100 for your favorite hotel or restaurant.

Doesn't that sound like fun?  Your friend gets a sensational smile-makeover and you get a sensational experience!

 
*FIRST NAME:
*LAST NAME:
*ADDRESS:
*CITY:
*STATE:
*ZIP:
*YOUR E-MAIL ADDRESS:
*PERSON YOU ARE REFERRING:
*MAY WE CONTACT THEM?:
THEIR PHONE NUMBER:
THEIR E-MAIL ADDRESS:
*TODAY'S DATE:
ANY COMMENTS:



 

Dr. Coker, a Tyler Dentist
921 Shiloh Rd., Suite A-100, Tyler, TX 75703
(903) 581-1777