Our office is known for its ability to provide unique dental services that support whole body health and function.
This type of customized care requires an additional level of patient cooperation in gathering the information that we need to care for our patients at the highest level of care.
In order to provide the level of service that requires extra attention to be paid to multiple aspects of healthcare as well as from multiple sources, we require the requested documentation (including any and all imaging/x-rays that are relevant to your care) to be completed and delivered to our office at least 48 hours before your scheduled appointment in our office. Failure to meet these requirements may result in the cancellation of your scheduled appointment.
PLEASE COMPLETE THE ONLINE PAPERWORK. IF YOU REQUEST A PAPER COPY PLEAE FILL IT OUT AND RETURN TO WeCare@WeAreSynergy.com OR YOU CAN FAX IT TO 618-281-9734. If you are sending in paperwork for more than one person please only use the email address. Thank you!
We believe that it is very important to fully inform you of your rights and responsibilities as a patient at Synergy Dental Solutions
In order to make the registration process as streamlined as possible we have created easy access to all paperwork and forms required to complete your new patient registration
Providing easy access to our forms and data gathering system will help us to maintain accurate information and the most recent updates on your health and insurance information
PLEASE SEND US YOUR DENTAL INSURANCE INFORMATION-NOT YOUR MEDICAL. A COPY OF THE FRONT AND BACK OF THE DENTAL CARD IS APPRECIATED. Do not send us your medical insurance information. Doing so will only delay the registration process. If we need to get records from your previous office please complete the Release of Records form , You may email your insurance card to WeCare@WeAreSynergy.com
New Patient Forms