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As a new or existing patient at Synergy Family Therapy Specialists, you will have to periodically fill out forms when you arrive to help us keep our records up to date. You can assist in this process by downloading the forms ahead of time and filling them out before you come in for your appointment. This page contains links to downloadable versions of our most frequently used forms.


New patients :

Please download, print, and fill out all of the intake paperwork forms, and bring them to your first appointment. Please note, we have two sets of intake paperwork forms. One is for Pediatrics (Under 18). The second is for Adults (18 and over). Please complete the most appropriate form.

The Pediatric Intake Paperwork is for patients under 18.



The Adult Intake Paperwork is for patients 18 and older.

Returning patients : 

If there have been any changes to your information please download, print, and complete the section that changed.

In order to continue to receive services in 2023, please download, print, and complete the 2023 annual intake paperwork.

To review our policies at any time, please download the SFTS policies document.



Physicians :

If you have a patient that would benefit from Physical Therapy, we would love to help them reach their goals. Attached is a copy of our Referral Form that you can print, complete, and fax to us. We will contact the patient and set up their first appointment. Please fax your referrals to 937-428-6274.





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