Note that printing may not work if Synapse is installed into a directory containing a space in the path. If you have installed it into c:\program files\synapsedirect\, try moving all these files into c:\emr or c:\synapse. Currently printing consultations is done from the consult screen. You select a consult from the list on the left, and then click on the "Print" button. But, because printing is for the purposes of sending a letter to another physician, you should have a correspondent assigned for a particular patient. To assign a correspondent, go to the Providers tab, search for a provider ( you have to have added a provider first of course ), and then make them the primary by using the "Primary" button. That provider will then appear as the primary correspondent on the Patients/Details/Personal & Contact tab. The Print button then gives you a number of options to choose the correspondent among the choices, font size, who the copies should go to etc. Use the PDFLatex button to allow MiKTeX to typeset the letter for you and to create a PDF. If nothing appears to happen, make sure that there is not a DOS box with an error screen ( printing uses DOS bat files to invoke MiKTeX ). If so, note the error, and exit by typing "x" in the DOS screen. Correct the problem in your text and try printing again. The error is because the MiKTeX interpreter has found an unrecognised escape sequence which you may have inadvertently typed. Another option is to print an encounter to be placed into a paper file. Use the "Docs" button instead ( new in build 163 ), and select the "A4 Encounter Document" style.