Synergy Therapeutic Group
  • About
    • Our Practice
    • Our Locations
    • Our Team
    • Join Our Team
    • Contact
  • Pediatric Therapy
    • Pediatric Programs
    • Pediatric Resources
    • Courses
    • What We Treat
      • Sensory Integration Disorder
      • Autism and Autism Spectrum Disorder
      • Handwriting Problems
      • Perceptual Difficulties
      • Motor Planning
      • ADD and ADHD
      • Cerebral Palsy
      • Fine Motor Delays
      • Dyspraxia
      • Learning Disability
      • Developmental Delay
      • Other Neurological Disorders From Birth
  • What We Treat
    • Back Pain & Sciatica Relief
    • Shoulder Pain
    • Neck Pain
    • Arthritis Pain
    • Chronic Pain
    • Vertigo & Dizziness
    • Women’s Health Issues
    • Headaches & Migraines
    • View More Conditions
  • How We Treat
    • Myofascial Release
    • Manual Therapy
    • Laser Therapy
    • Occupational Therapy
    • Pelvic Floor Therapy
    • Physical Therapy
    • Vestibular Therapy
    • Wellness Program
    • Dry Needling
    • TMJ
    • Post-Surgical Rehab
  • Patient Info
    • Direct Access
    • Insurance Info
    • Patient Forms
    • Financing & Payment Options
    • Your First Visit
    • Patient Success Story
      • Adult Success Story
      • Pediatric Success Story
    • FAQs
    • Referral Program
    • Patient Survey
    • Physician’s Office
  • Health Tips
    • Webinars/Workshops
    • Quizzes
    • Downloads
    • Health Blog
    • Ebooks
  • Request Appointment
Patient Info / FormsLogo
  • CALL US
    • Carbondale
      ✕
      • Please Select an option below for us to best direct your call Carbondale

      • New Patient / Inquiries
      • Current Patient
      • Other
    • DU QUOIN
      ✕
      • Please Select an option below for us to best direct your call DU QUOIN

      • New Patient / Inquiries
      • Current Patient
      • Other
  • Request Appointment
Patient Info / FormsLogo
  • About
    • Our Practice
    • Our Locations
    • Our Team
    • Join Our Team
    • Contact
  • Pediatric Therapy
    • Pediatric Programs
    • Pediatric Resources
    • Courses
    • What We Treat
      • Sensory Integration Disorder
      • Autism and Autism Spectrum Disorder
      • Handwriting Problems
      • Perceptual Difficulties
      • Motor Planning
      • ADD and ADHD
      • Cerebral Palsy
      • Fine Motor Delays
      • Dyspraxia
      • Learning Disability
      • Developmental Delay
      • Other Neurological Disorders From Birth
  • What We Treat
    • Back Pain & Sciatica Relief
    • Shoulder Pain
    • Neck Pain
    • Arthritis Pain
    • Chronic Pain
    • Vertigo & Dizziness
    • Women’s Health Issues
    • Headaches & Migraines
    • View More Conditions
  • How We Treat
    • Myofascial Release
    • Manual Therapy
    • Laser Therapy
    • Occupational Therapy
    • Pelvic Floor Therapy
    • Physical Therapy
    • Vestibular Therapy
    • Wellness Program
    • Dry Needling
    • TMJ
    • Post-Surgical Rehab
  • Patient Info
    • Direct Access
    • Insurance Info
    • Patient Forms
    • Financing & Payment Options
    • Your First Visit
    • Patient Success Story
      • Adult Success Story
      • Pediatric Success Story
    • FAQs
    • Referral Program
    • Patient Survey
    • Physician’s Office
  • Health Tips
    • Webinars/Workshops
    • Quizzes
    • Downloads
    • Health Blog
    • Ebooks
Home » Patient Information » Patient Info / Forms
  • Quick links

    • Patient Info / Forms
    • Our Locations
    • FAQs
    • View More Conditions (library)
  • Request Appointment

    Team Photo

    Are You Ready To Live Pain-Free?

    Request Appointment
  • Latest Blogs

    Strategies to Enhance Mobility and Independence for Individuals with Cerebral Palsy

    Read more

    SUBSCRIBE TO OUR HEALTH BLOG

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

Patient Info / Forms

We are here to help you enjoy your life, pain-free! To make a convenient appointment, simply call us today. Our practice is dedicated to helping our patients recover from all types of injuries and surgeries. Our goal is for you to get better and back to your normal activities.

Patient Forms

At Synergy Therapeutic Group, our physical and occupational therapists want to maximize your time with us. Prior to your first visit, please print and complete the New Patient Forms below. Please bring these completed forms, your insurance cards, and your photo ID with you to your first visit. Otherwise, allow extra time before your appointment to fill them out here.

  • 1

    New Patient Packet

    Download and Print
  • 2

    First Contact Sheet

    Download and Print
  • 3

    Consent To Treat A Minor

    Download and Print

Before Your First Visit

  • Make a list of questions and concerns you would like to discuss with your therapist.
  • List signs and symptoms that can be of importance to the therapist.
  • Have in writing key past medical history, previous treatments, current medications, and other important information.
  • Please call our office to verify your insurance benefits.
  • Arrive 15 minutes early for your first appointment.
  • Bring with you a copy of your insurance card and a photo ID.

What to Expect on Your First Visit

  • You will register with our friendly front office staff. They will help you navigate the insurance process and treatment program so you can focus on your recovery.
  • You will meet with your physical therapist for the initial evaluation.
  • During the evaluation your therapist will ask questions about your medical history, current pain, or injury. Your physical therapist will also answer any questions you may have about therapy and your condition. Open communication helps us get you better.
  • Your movement, strength, coordination, and much more will be evaluated. Our purpose is to help you, so please communicate to your therapist if anything is hurting or bothering you during the examination.
  • Your therapist will recommend and prepare a course of treatments to ensure the quickest recovery and the best results. Your therapist will discuss the recommendations with you.
  • There will be some treatments performed the first day to get you started on your road to recovery. However, during the next visit you will get into the full swing of your treatment plan.
  • You will schedule a series of visits with the front desk. The amount of therapy needed will be discussed with you, depending on the recommendations of your therapist and physician. We offer many convenient appointment times.
  • Your therapist will write up their findings and treatment plan to submit to your referring physician or other medical professional who you choose.
  • If you have any questions at anytime, please don’t hesitate to call. We want to ensure your satisfaction and full recovery
  • About
  • Pediatric Therapy
  • What We Treat
  • How We Treat
  • Patient Info
  • Health Tips

Carbondale

1110 N Cedar Court,
Carbondale, IL, 62901

P: 618-243-7822

F: 618-529-4560

E: synergytherapeuticgroup2@yahoo.com

Mon 08:00 am – 05:00 pm
Tues 08:00 am – 05:00 pm
Wed 08:00 am – 05:00 pm
Thurs 08:00 am – 05:00 pm
Fri 08:00 am – 05:00 pm
Sat/Sun Closed

Read our reviews on google

DU QUOIN

12 South Division Street,
Du Quoin, IL, 62832

P: 618-542-8950

F: 618-529-4560

E: synergytherapeuticgroup2@yahoo.com

Mon 08:00 am – 12:00 pm
Tues Closed
Wed 08:00 am – 12:00 pm
Thurs Closed
Fri 08:00 am – 12:00 pm
Sat/Sun Closed

Read our reviews on google
Patient Info / FormsLogo
FIND US ON SOCIAL MEDIA!
  • social icon
  • social icon
  • social icon
  • social icon

© Synergy Therapeutic Group 2026 | Sitemap | Privacy Policy | Terms of Use |

Practice Promotions