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Client Intake Questionnaire

Are You a Candidate for Syntonic's Intravenous Infusions or Transcranial Magnetic Stimulation Therapy?

Looking for the Referral Form instead? Find it here.

​​The first step of the process with Syntonic is always to ensure that your experience will be both safe, and a helpful catalyst for sustained wellbeing. 

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To find out whether Syntonic's Intravenous Infusion Program (with optional integration therapy) or Transcranial Magnetic Stimulation (TMS) is the right option for you, please complete our intake form below.

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NOTE: Once submitted, a member of our clinical team will review the submission and be in contact within 48 hours on a weekday to discuss the next steps, including setting up an intake appointment at Syntonic, situated in Saxonwold, JHB. 

Intake Questionnaire (Client)

This information is used to ensure co-ordination between treating professionals in the best interest of each client.

Please indicate whether you are seeking TMS or Intravenous Infusions by selecting from the drop-down menu:
Do you currently present with one or more of the following diagnoses or mental health concerns? Please select all that apply; or choose Not Applicable if none apply.

This section will assist us in screening for any psychological conditions that my preclude you from safely participating in our treatment-resistant therapy programs.

This section will assist us in screening for any medical conditions that my preclude you from safely participating in our treatment-resistant therapy programs.

+27 63 782 4975

info@syntonic.me

73 Oxford Road, Saxonwold, 2055, South Africa

All Rights Reserved. Syntonic. 2025

Syntonic_Psychiatrists, Psychologists at 73 Oxford Road, JHB
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