Partner Site application

Tell us about your practice.

A short application that takes about 2 to 3 minutes. Synergy reviews your practice, location, patient population, clinical capabilities and areas of interest.

Start the application

A practice owner completes an online application at his desk

Three short sections

Your practicePractice profile and contact details.
Your clinical settingCapability and readiness.
Your opportunityPartnership fit and timing.

Application note: Please do not enter private patient information. Your answers will be saved for application review.

01 / Practice profile

Your practice

1. Type of healthcare professional or practice

2. Practice details

Practice name

Contact name

Credential and license information

City and state

Practice website, if available

Phone

3. Years operating

4. Approximate monthly patient or client visits

02 / Capability and readiness

Your clinical setting

5. Patient populations currently served

6. Regenerative or related services currently provided

7. Synergy programs you would like to explore

8. Clinical infrastructure

Treatment rooms available

Licensed personnel on site

Relevant equipment and operating infrastructure

03 / Partnership fit

Your opportunity

9. Which patient source best describes your opportunity?

Practice-originated Synergy-acquired and routed Both

Monthly capacity for additional patients

10. Type of relationship you would like to explore

11. Launch timeframe

12. Why would your practice be a strong Partner Site?

I confirm that the information is accurate to the best of my knowledge. I understand that professional, clinical, licensure, scope, facility and compliance requirements apply. I understand that submitting an application does not imply acceptance, authorization or approval. I authorize Synergy to contact me about this application.

Application received

Thank you for applying.

Your application has been saved. Synergy may review practice capabilities and may invite qualified applicants to a Partner Strategy Call.

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What happens next

Qualified applicants are invited to a Partner Strategy Call.

Together we determine the right program, operating model and launch pathway for your location. Submitting an application does not guarantee acceptance into the Synergy network.