Medical Records

If you would like to share your medical records or need your medical records sent to another medical provider you can use our pdf form or use our fillable form to complete your request. If you are having trouble using either of these options please print out the form, fill it out the form manually and email it to admin@synergiquehealing.com or fax it to 281-972-8349.Please be aware if the medical records you are requesting are not for a medical provider there is a fee of $25 for the first 20 pages and $0.50 for each page after the 20th page. All medical records requests are addressed as a first come first serve basis and can take up to 15 business days to be sent off.

If you need to send us any medical records, lab results or any medical information or documentation you can send us your information via email at admin@synergiquehealing.com or via fax at 281-972-8349. Please make sure to include the name of the patient and date of birth to avoid delays.

Authorization To Disclose Medical Information