Intake Department Forms

Client Information

For your review only; no need to return.

Syntero Client Rights & Other Notices

Dublin Office
Lewis Center Office
Mill Run Office
Mount Gilead Office

New Client Paperwork

Complete prior to your first appointment. Please download, print, complete and bring paperwork to your appointment. You can also complete this digitally and email frontdesk@syntero.org.

Intake Form - Adult
Intake Form - Youth
Informed Consent for Minors
Intake Form - SUD (this is a supplemental form to be completed together with either the Adult or Youth Intake Form)
Intake Form - Psychiatry

Other Syntero Forms

Complete the following forms, as needed. Please download, save the forms, then submit via email to frontdesk@syntero.org.

Release of Information
Client Turning 18
Sliding Fee Application

Contact

Please direct questions to our Intake Department at intake@syntero.org or 614.889.5722 ext 133.