Feedback Form Fill in as much or as little as you like. Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code What is your connection with Synergy Wellness? Or: Client Family Staff member in another agency Did Synergy Wellness make a positive difference to your life and situation?How do you find Synergy Wellness overall?What was good about Synergy Wellness? What could be improved at Synergy Wellness? Please comment on the following areas of our service1. Intake and Referral 2. Our understanding of your circumstances 3. Our work in first getting services for you from the support agencies 4. How we kept in touch and assisted you to alter and improve those services Do you want to hear back from us? Yes No If yes, please fill out your email address
