Admissions

Mon - Sat 8:00 - 6:30

Visit Our Place

751 Payne Ave, Saint Paul, MN 5513

Admissions Process

Thank you for your interest in services at Synergy Treatment Center. Please complete this short form to help us better understand your needs. Your responses are confidential.

Client Contact Form

Contact Information

Full Name

Date of Birth

Email Address

Phone Number

Preferred Method of Contact

Substance Use Information

Are you seeking services for yourself or on behalf of someone else?

Have you received substance use treatment before?

When was the last time you used alcohol or other substances?

What substance(s) do you currently use or have concerns about?

Alcohol Marijuana Cocaine Prescription Drugs Other

How often are you using these substances?

Are you currently on any medication to support recovery?

General Well-Being

Do you have a safe place to stay at this time?

Do you have any legal involvement related to substance use?

What insurance do you currently have?

Is there anything else you would like us to know?

751 Payne Ave, Saint Paul, MN 55130

Mon - Sat 8:00 - 6:30

Admissions

751 Payne Ave, Saint Paul, MN 5513

Admissions Process

Client Contact Form

Contact Information

Substance Use Information

General Well-Being

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