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Forms

Red Hook, St. Thomas USVI

Patient Intake Form

Complete this form if you are interested in physical therapy, nutrition counseling, naturopathic medicine, or speech-language therapy.

Mental Health Intake Form

For your convenience, we have attached the following forms. Please complete all the applicable fields and bring the form(s) to Synergy along with a valid photo ID and insurance card(s). Patients are required to complete this paperwork prior to visiting a provider or the fitness center. Otherwise, please come to our office at least 15 minutes before your appointment to complete the paperwork. You must still contact Synergy to schedule an appointment.

Gym Intake Form

For your convenience, we have attached the following forms. Please complete all the applicable fields and bring the form(s) to Synergy along with a valid photo ID and insurance card(s). Patients are required to complete this paperwork prior to visiting a provider or the fitness center. Otherwise, please come to our office at least 15 minutes before your appointment to complete the paperwork. You must still contact Synergy to schedule an appointment.

Massage Intake Form

For your convenience, we have attached the following forms. Please complete all the applicable fields and bring the form(s) to Synergy along with a valid photo ID and insurance card(s). Patients are required to complete this paperwork prior to visiting a provider or the fitness center. Otherwise, please come to our office at least 15 minutes before your appointment to complete the paperwork. You must still contact Synergy to schedule an appointment.

Speech Case History Adult

For your convenience, we have attached the following forms. Please complete all the applicable fields and bring the form(s) to Synergy along with a valid photo ID and insurance card(s). Patients are required to complete this paperwork prior to visiting a provider or the fitness center. Otherwise, please come to our office at least 15 minutes before your appointment to complete the paperwork. You must still contact Synergy to schedule an appointment.

Speech Case History: Infant -School Aged (18 years)

For your convenience, we have attached the following forms. Please complete all the applicable fields and bring the form(s) to Synergy along with a valid photo ID and insurance card(s). Patients are required to complete this paperwork prior to visiting a provider or the fitness center. Otherwise, please come to our office at least 15 minutes before your appointment to complete the paperwork. You must still contact Synergy to schedule an appointment.

Notice of Privacy Practices

For your convenience, we have attached the following forms. Please complete all the applicable fields and bring the form(s) to Synergy along with a valid photo ID and insurance card(s). Patients are required to complete this paperwork prior to visiting a provider or the fitness center. Otherwise, please come to our office at least 15 minutes before your appointment to complete the paperwork. You must still contact Synergy to schedule an appointment.