Free Consultation Questionaire
Fill in the information below with as much detail as you can. This information is sent directly to our physicians at Synergistic Health Centers. This information will be held confidential between you and Synergistic Health Center physicians.
Please complete the following
Your Name
Your Email
Phone Number
Date of Birth

Women - Exams (check if you've had in the last year any of the following exams)

Have seen a physician for hormone therapy
Are you currently on meds for hormone therapy?
Any major health problems?

Hysterectomy (women)
Insurance Company (Enter "none" if you don't have insurance)
Send  Reset

950 E. Alex Bell Rd., OH, 45459


Please note: Weight loss results vary individual to individual.