Synergy Wellbeing

  • Thank you for taking the time to answer these questions.

    This will help us get a better idea on how to serve you best.

    Just answer to the best of your knowledge.

    Don't want to take the survey? Give us a call 918-749-1840, option 4

  • In which age group is the person for which counseling is being sought?

  • Would you like/expect anyone else to participate in counseling with you?

  • How do you plan to pay for counseling?

  • If the best counselor for me is not in my network, I would be willing to pay privately or out of network. (cost can range between $95.00-$175.00 per session)
  • For what issues(s) or concerns(s) are you seeking counseling?

  • We know how important it is to find a counselor who “gets” you. Synergy Wellbeing’s unique CARE NAVIGATOR SURVEY is designed to help us find the right counselor for you.

  • What do you most enjoy doing with your leisure time or to relax?

  • How did you hear about us?

  • Please indicate your preferred method of contact:*
  • Format: (000) 000-0000.
  • Is it alright if we contact you to get more information about your concerns?*

  • Synergy Wellbeing is committed to protecting your privacy and complies with the Telephone Consumer Protection Act (TCPA) and industry standards for text messaging. We will not share your mobile phone number with third parties. We will only respond to this survey via text if you explicitly request that we do so. You can opt out at any time by replying 'STOP' to the message. Your personal information is securely stored and used solely to facilitate your communication with us.

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