Whom are you seeking services for: (Mark only one)
If you are requesting services for someone else, are they aware of this request?
Please tell us about you (please select all that apply)
What is the age group of the person that you are seeking services for?
Please describe the kind of counselling you are seeking
Thank you for completing this request form. The information submitted will be held confidentially by SCAGO and not shared with other individuals or outside agencies without your documented verbal or written consent. We will contact you within 14 business days of receipt of this form to conduct a phone or virtual consultation to discuss your needs further. Note that SCAGO counselling services are short-term, do not constitute crisis or urgent care or medical advice, and are not intended to substitute for medical treatment or care. If you are experiencing an emergency or crisis, please call 911 or visit your nearest Emergency Room. Please click the appropriate option below if you agree with these terms and permit us to contact you.