Physician Resources


Synergy Medical Supply makes it convenient for our health-care facilities to fax an order:

  1. Download the prescription form.
  2. Please complete and print out prescription form with the required information:
  • Date and Start Date and Length of Need 
  • Patient Name and Address Demographics 
  • Patient Date of Birth
  • Patient Height & Weight 
  • Fill Out the Appropriate Order Information
  • Include any insurance or testing information with your order form
  • Physician Printed Name and Signature are also Required
  1. FAX the forms to Synergy Medical Supply toll-free at (888)461-3210