Welcome to Synergy Dental
NEW PATIENT FORM
Please fill out this form if you have never been to Synergy Dental Before.
Your Information is securely emailed to our reception staff and will always remain Private and Confidential.
Due to covid and the need to streamline the patient process we would greatly appreciate if you could fill out this online form.
We look forward to providing you and your family with honest and quality dental care!
Payment Information
Please note, we do not offer in house credit to new patients at this time.
We do offer ZIP as a payment plan option which can be accessed on your phone after your appointment. LEARN ABOUT ZIP >
Southern Cross insurance works really well here and claims are processed on-line following your appointment. LEARN ABOUT SOUTHERN CROSS >
ACC claims work really well here. These will be filed online following your appointment. LEARN ABOUT ACC DENTAL CLAIMS >
New Patient PDF Form For Download
For your convenience we have added our new patient from here for download.
Please Click the IMAGE and the PDF form will download for you.
Once downloaded please print and fill out prior to coming in for your appointment.
Thank you.