Online Forms


New Patient Health History Form - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

New Patient Paperwork


Accident History Form

If you were involved in an accident please print and fill out this form when you come to your first appointment.

Accident History Form


Synergy Spine and Injury Center offers our patient form(s) online so they can be completed it in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

$29 INITIAL EXAMINATION / X-RAYS (if necessary) ($380 VALUE)

Fill In Your Information Below; Medicare Patients Ineligible

Location

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Office Hours

Our Regular Schedule

Monday:

8:00 am-11:00 am

2:00 pm-5:00 pm

Tuesday:

2:00 pm-6:00 pm

Wednesday:

8:00 am-11:00 am

2:00 pm-5:00 pm

Thursday:

2:00 pm-6:00 pm

Friday:

8:00 am-12:00 pm

Saturday:

9:00 am-12:00 pm

Sunday:

Closed