Patient Info Changes

Have you had any changes in your contact information recently? Or do you want to update information on your chart? If you need to update any information on your chart, please use the following forms to make us aware of any changes. You may also email us at admin@synergiquehealing.com or call at 713-840-7956 to make some of these changes. You may use any of the following PDF forms to fill out and have sent to us via email or please fill out the following page to make the updates. **Please keep in mind that these changes can take 1-2 business days to update.**

Credit Card Authorization
Payment Plan Agreement
Update Emergency Contact Request
Update Insurance Information