Thank You

Thank You for Requesting an Appointment with SynergenX

Thank you for filling out our online form requesting an appointment with SynergenX to help you reinvigorate your life and how you feel about yourself. One of our caring, knowledgeable staff members will contact you to find and confirm a time convenient to your schedule.

We look forward to seeing you soon!

Also, you can always call us directly at 888-219-7259.

New Patient Appointment Booking

First Name(Required)

Last Name(Required)

Date of Birth(Required)

Gender(Required)

Last 4 of SSN(Required)

Email(Required)

Phone(Required)

Location(Required)

Services(Required)

Appointment Date(Required)

Appointment Time(Required)

Insurance

Save time at your appointment by filling out your insurance information. (optional)

Insurance Provider(Required)

Relationship to the policyholder

Group ID

Member ID(Required)

Female patients, please note, we request you to bring an up-to-date mammogram and PAP results to your appointment. It is recommended that you conduct your test on days 18-21 of your cycle if you are still cycling.

This field is for validation purposes and should be left unchanged.