Synapse Functional Medicine Programs Questionnaire
Thank you for your interest in receiving care at Synapse Center for Health and Healing. The questionnaire below will guide your onboarding process and help us provide the best patient experience. If you have any questions, give us a call at 651-209-9906 or email us at
Date of Birth
How did you hear about Synapse?
Current/Previous Patient Referral
Surviving Mold Website
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This form was created inside of Synapse: Center for Health and Healing.