© 2019 by Synergize Direct Primary Care

85 N Lansdowne Ave, Suite #4, Lansdowne, PA 19050

Tel: 215-876-0360

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Instructions

Fill out all applicable fields in the enrollment form panel to complete your registration process. If you are unable to see any information in the enrollment form panel, or the information appears to be displayed incorrectly, try refreshing your web browser to reload the form. You may also load the enrollment form as a full page document by clicking the “open in fullscreen” button present in the form panel.