Are you due for a refill? Thank you for using our refill request page. Please complete the following form or you can also email us at admin@synergiquehealing.com. We will reply to you the same day or at the latest 2 business days. If this is an emergency please call 911 or go to the closest emergency room for immediate assistance. If you need to change your pharmacy you may add the new information with your request or please fill out the following PDF document and submit it to our email at admin@synergiquehealing.com

Send Us A Message

Patient's First Name*
Patient's Last Name*
Date of Birth*
MM slash DD slash YYYY
Phone*
Email*
Pharmacy Name*
Pharmacy Phone*
Pharmacy Address*
Street Address Address Line 2 City State ZIP Code
Medication and Strength Requested*
Attach File(s)
Accepted file types: pdf, jpg, jpeg, png, doc, docx, Max. file size: 256 MB.
Consent
By submitting this form, I acknowledge that I read, understand and consent for Synergique Healing, to update my information & submit my refill request and I am aware I can change my request at any given time upon my written request.
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Synergique Healing, PA

8703 Meadowcroft Dr
Houston, TX 77063

Phone: (713) 840-7956

Fax: (281) 972-8349

Business Hours

Monday -Thursday 9 am – 5 pm
Friday 9 am – 3 pm
Saturday & Sunday: Closed

Refill Requests

Synergique Healing, PA

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