Welcome to Synergy Practice Solutions PM&R Z-Forms
Medical office forms by Synergy Practice Solutions
Medical office forms by Synergy Practice Solutions
Medical office forms by Synergy Practice Solutions
Medical office forms by Synergy Practice Solutions
Medical office forms by Synergy Practice Solutions
Medical office forms by Synergy Practice Solutions
Medical office forms by Synergy Practice Solutions
Medical office forms by Synergy Practice Solutions
Medical office forms by Synergy Practice Solutions
Medical office forms by Synergy Practice Solutions
Medical office forms by Synergy Practice Solutions
Medical office forms by Synergy Practice Solutions
PM&R Form List NP IN SB P1 P2
 Outpatient Forms
Acupuncture •
ADL Dysfunction • • • •
Amputation • • • •
Baclofen Pump Refill •
Chronic Pain • • • •
Chronic Pain addendum •
CVA • • • •
EMG •
Low Back Pain • • • •
Lower Extremity Pain/Injury • • • •
Multiple Trauma • • • •
Neck Pain • • • •
Shoulder Pain/Injury • • • •
Tetraplegia • • • •
Total Hip/Knee Replacement & Hip Fracture • • • •
Traumatic Brain Injury • • • •
Upper Extremity Pain/Injury • • • •
 Inpatient Forms
Consultation Form •
Coumadin Management Form •
History & Physical Form •
Progress Note •
Team Note •
 Administrative Forms
Therapy Rx •
Medication Form •
Referral Letter •
Patient Demographics •
Patient History •
Equipment RX •
NP – new patient form
IN – initial follow-up
SB – subsequent follow up
P2 – 2 pages
P1 – one page only

Page 2 for each ailment is the same for NP, IN, and SB visits.

Combination Forms allow you to use one form for a New Patient, Initial Followup, and Subsequent Followup.
The packages include the same forms and extras.

PM&R Package Pricing

16 ailments
Single Ailment $25.00 each
Single Combined Ailment $15.00 ea.
$315.00 for Full Package
$250.00 for Combined Package

Non-customized forms:

View, purchase and download forms available online

CDs can be mailed for an additional $5.00/CD.

Customized Forms:

These packages do not include customized headers.
For customized header add $100.00 per package.
Single forms add $10.00 each.
Additional customization, $50.00/hr.
Please allow 5-7 business days.

All prices subject to change.