SCAGO Portal

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Your progress is saved locally and will resume automatically on return.

Your Details

First name*

Last name*

Primary phone number*

Alternate phone number (optional)

Email*

City*

Postal code*

How We Can Reach You

How would you prefer we contact you?*

Phone call

Text message

When is the best time to reach you? (select all that apply)

Weekday mornings

Weekday afternoons

Weekday evenings

Weekends

Is it okay for us to leave a voicemail that mentions SCAGO?*

Yes, a voicemail is fine

No, please don't leave a voicemail

About Your Request

Terms & Conditions Agreement

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.

I hereby verify that all information provided on this form is true*

I agree to these terms.*