Sinergy.net.au:: Online Request

Online Request
Welcome to Sinergy's Online Request service. Using the form below, you can contact us online to organise an appointment with one of our doctors. Alternatively, you can telephone us on1300 304 144. You should expect to be contacted by the Sinergy Team within one (1) working day.

If you require assistance in deciding on the most appropriate specialist for your client, you can email our Sinergy Team now or telephone 1300 304 144.

Referral Visit

Doctor you wish to see:
Location:
Nature of injury:
Patient's Details:
Claim No.:
Special Instructions:
Preferred Dates: (please provide at least two options)	1) 2) 3)

Your details

First Name:
Last Name:
Company:
Telephone:	-
Email:
Preferred contact method:	Email Telephone

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