1. Please Download/Print and fill out below Referral and Information Release for the patient.

2. Attach any relevant documents Including: Patient summary, Insurance Information, Medication lists, laboratory results.

3. Submit Paperwork 

   1. Fax to +1 814-357-7241

   2. Email to Referral@mysynergytherapeutics.com

   3. Submit through our secure portal: Here

4. Rest easy, know the patient is in good hands, and we will be reaching out to them shortly.

If you have any questions, dont hesistate to reach out to us at  Referall@mysynergytherapeutics.com or at  (814) 919-9355

Thank you for your trust in caring for this patient. 🥰