To begin your journey with us, please complete the following forms.
Forms for New Clients
These PDFs are fillable; save them with your name as part of the file name. You can bring them to your first session or email them as instructed.
If you have any questions or need assistance with these forms, please contact us directly.
Service Forms
Complete one or more service forms to provide us with essential information about yourself and your goals. Intake forms should be sent no later than 24 hours prior to your first session to ensure your coach has all relevant information beforehand.
Limits of Confidentiality/Therapy Cancellation Policy
This form outlines the boundaries of confidentiality and our policy on session cancellations.
Authorization to Disclose Information Form
If you would like us to coordinate care with another provider (e.g., psychiatrist, primary care physician), please complete this form to authorize the release of information.
Our Availability
Monday, Wednesday, and Friday
12pm – 8pm
Saturday
11 AM – 5 PM
Sunday
1PM – 4 PM
Pricing
This is a fee-for-service practice:
Intake Session
Complimentary
75 Min
1:1 Coaching
$125 (virtual)
$175 (in-person)
60 Min
Couples Sessions
$275 (virtual)
$325 (in-person)
75 Min
Mid-session Check-in
$75 (virtual)
30 Min
Support System Session
$125 (virtual)
30 Min
Job Seekers Package
$1,675 (virtual)
$2,000 (in-person)
10 sessions of 1:1 coaching
Resume & Interview Prep
Unlimited Mid-session Check-ins
We aim to be inclusive.
We offer sliding scale fees for individuals experiencing hardship. If you need financial assistance and/or are unable to pay the above rates, please contact us to discuss our sliding scale and payment plans.
FAQs
What kind of services are provided?
All coaching services and communication from Synergy Wellness & Coaching LLC, delivered by Asa Flonette Scott (your “Coach”), are designed to help you identify areas in your life and thinking that may be standing in your way. Coaching is not a substitute for emergency mental health or medical care. If you are in an acute crisis and require emergency support, please immediately call 911 or seek services at your nearest emergency care center. By engaging in coaching services, you confirm that you have read and agree to the following:
- You release and discharge your Coach and any related parties from any claims or demands arising from the coaching relationship.
- You are fully responsible for your well-being during and after coaching sessions, including your choices and decisions.
- Coaching is not a substitute for counseling, psychotherapy, psychoanalysis, mental health care, or substance abuse treatment.
- Your Coach’s comments and ideas are intended to aid you in achieving your goals, and you give informed consent to receive this assistance.
- Your Coach does not promise specific outcomes, such as increased clientele or business success.
- Your Coach will protect your information as confidential unless you state otherwise in writing or if required by law.
- You accept the risks of using technology for communication, including email, text, phone, and video calls.
What is eligibility to engage in services?
- 18 and older
- Virtual services offered
- In-person services available in NYC only
Coaching is not for everyone:
Let’s be honest and transparent. Unlike other programs, coaching is not for everyone. Here are three reasons you should NOT work with a coach:
- You are not ready to change. If you’re not willing to do the work and are looking for a quick fix, we are not for you. Coaching requires action and readiness to move forward.
- You need emergency services. If you are experiencing severe impairment and need a qualified medical professional, coaching is not a substitute.
- You are not willing to change. If you’re more committed to staying where you are, feeling helpless, complaining, or blaming others, coaching may not be beneficial for you.
How often will I meet with my coach?
During the first session, the coach and client will determine goals and set the rhythm for future sessions. This individualized approach allows the client to decide the frequency of sessions, always keeping a target date and goal in mind.
Do you have physical locations?
We offer in-person services in NYC, available after the initial consultation and goal-setting sessions. These sessions require a deposit and are non-refundable if canceled within 48 hours prior to the appointment.
Can I still use coaching services if I already have a therapist?
Yes, coaching is not a substitute for psychiatric and mental health services. Synergy Wellness & Coaching often collaborates with mental health professionals to support the individual goals of their shared clients. Clients must sign releases and authorizations to allow cross-team collaboration.
Does Synergy offer psychiatry services and medication support?
No, coaching is not treatment, and thus Synergy Wellness & Coaching does not offer medication or psychiatry services.
Pricing
This is a fee-for-service practice:
- Intake Session (75 min): Complimentary
- Couples sessions (75 min): $275 (virtual) / $325 (in-person)
- 1:1 coaching (60 min): $125 (virtual) / $175 (in-person)
- Job seekers package (10 sessions of 1:1 coaching, resume & interview prep) with unlimited mid-session check-ins: $1,675 (virtual) / $2,000 (in-person)
- Mid-session check-in (30 min): $75 (virtual)
- Support System Session (30 min): $125 (virtual)
At Synergy Wellness & Coaching, we aim to be inclusive. We offer sliding scale fees for individuals experiencing hardship. If you need financial assistance or are unable to pay the above rates, please contact us to discuss our sliding scale and payment plans.
In Case of Emergency
If you or someone you know is in imminent danger or crisis, please don’t wait to find support. Coaching is not a substitute for emergency medical services. The resources below can quickly and effectively direct you to safety:
- Call 911 or visit your nearest emergency room if there is immediate danger.
- Call 988 or text 988lifeline.org to reach a 24-hour suicide and mental health crisis helpline.
- Call the National Domestic Hotline at 1-800-572-SAFE (7233) for anonymous, confidential help for domestic and intimate partner violence.