SCARS Consent For Support Services Intake Form

Please Note

SCARS is a professional crime victims’ assistance and services provider. The following information is necessary for us to provide quality of care and meet our legal responsibilities. With this, you are granting your consent for our organization to help and support you.

Join the SCARS Institute 120 Recovery Program for Scam Victim-Survivors
Apply Here for the SCARS Institute's 120™ Recovery Program (Support Program) for Scam Victim-Survivors who are committed to their recovery after their scam.
Please read each section and answer each question carefully. Respond as completely as possible so that we can best help you. One word answers are not the right way to tell us how to help you. We are professionals, and provide professional care to those we support. This is the reason we ask this information.
Your Name(Required)
We are a professional crime victims' services provider, we need to know who is asking for our services.
First Last
Your Date Of Birth(Required)
By U.S. Law - COPAA - We are required to ask your age for all participation in our online activities. Please enter your birth date for age verification. We also require this to confirm you are an adult.
M
D
Y
Are you interested in joining a SCARS Scam Victim's Support & Recovery Group?(Required)
There is no cost for our support and recovery program
- YES
- NO
Is this for yourself or someone else?(Required)
- Myself
- A friend or family member
- Someone else
Are you?(Required)
- A Scam Victim
- Not a Scam Victim
- Family or Friend of a Scam Victim
What Languages Do You Speak & Read Well?(Required)
- English
- Spanish
- Other
- I Use Google Translate
What is YOUR Preferred Language?(Required)
You must be functionally able to speak or understand English or Spanish to get the most from our Support Groups. However, our SCARS Partners offer support in other languages.
- English
- Spanish
Tell Us About You
Sex(Required)
SCARS does not discriminate based upon gender roles. This is strictly to aid in identification.
- Female/Woman
- Male/Man
Your Location(Required)
This helps us understand how to help you report to your local police or access other local services for victims of crimes.

City State / Province / Region Country
Do you have a Facebook Profile?(Required)
Our support groups are on Facebook, so you must have a Facebook profile to access our support groups.
- Yes
- No
Your Facebook Profile Link(Required)
The SCARS Institute 120 Recovery Program uses Facebook for its private/confidential online support groups and chats - We need this to confirm your identity and spot scammers or fakes, AND that you have a Facebook Account. If you do not know how to find this link, go to your PROFILE SETTINGS - you should see your profile link on that FB page. If you are on your App and see your HOME - click on the Profile Photo, then the THREE DOTS, then at the bottom of the Profile Setting page will be your Link! If using a browser, you will find your profile link in the address bar/fiend.
How many years have you had your Facebook Profile?
Just enter the number of years. If it is less than one year, enter 0
Please enter a number from 0 to 20.
Do you have a LinkedIn Profile?(Required)
We now offer support groups on LinkedIn too
- YES
- NO
Your LinkedIn Profile Link
We also offer support groups on LinkedIn - We need this to confirm your identity and spot scammers or fakes, AND that you have a LinkedIn Account. You can get your profile link from your LinkedIn profile.
Do you have a Reddit Profile?(Required)
We now offer support groups on Reddit too
- YES
- NO
Do you have a Reddit Profile? What is your r/ account name?
Enter your Reddit account or profile identifier "r/..." -- If you have none, please enter NONE
Your Email(Required)
We need this to send you the invitation to join one of our Facebook support groups.
Your Phone (Optional)
This is optional, but often we follow up with victims before onboarding them into our groups. We ask for this so that in the event of a crisis or other concern that we might reach out to you and offer help. It also helps us spot fakes or scammers asking to join.
Can You Tell Us Who Referred You To SCARS? Or How You Found Us?(Required)
- Other SCARS Group or Information
- Facebook Page or Group
- On Another Social Media
- Google Search
- Another Anti-Scam Group or Organization?
- Referred By Law Enforcement/Police
- Referred By Another Victim
- Referred By A Family Member or Friend
- Other
If You Were Referred By Another Organization/Group/Entity, Please Give Us Their Name?
Tell Us About What Happened/The Crime
Have you been the victim of more than one scam?(Required)
- YES
- NO
How many scams have you been involved in?(Required)
The Following Questions are about the Most Recent Scam

You can add any additional details about past scams, frauds, or cybercrimes in the general fields below
Type Of Crime(Required)
- Romance Scam/Fraud
- Local Scam
- Pig Butchering Relationship/Investment Scam
- Phone Scam
- Tech Support Scam
- Sextortion/Blackmail Scam
- Ecommerce/Shopping Scam
- Loan Scam
- Lotto Scam
- Marriage Scam
- Local - In Person Scam
Did you develop a relationship with the Scammer?(Required)
- Yes
- No
Was your scam?(Required)
- Online/Long Distance Only (Chat/Phone/Video)
- In person (someone you met in person)
- A marriage scam (you married the real person)
Approximately, when did the Scam START?(Required)
An approximate date is ok
When did the Scam END?(Required)
How many days, weeks, or months ago did it end? When was your last conversation or communication with the criminals?
Did YOU send Money to the Scammers?(Required)
- Yes
- No
Did YOU RECEIVE Money from the Scammers or Anyone Else for the Scammers?(Required)
- Yes
- No
Did YOU give access to Your Financial Accounts? Or Did YOU Create Accounts for the Scammers?(Required)
- YES
- NO
- Not Sure
Did YOU REPORT the Crime to your Local Police yet?(Required)
- Yes
- No
Did YOU REPORT the Crime to your National Police yet?(Required)
Includes: Secret Service, FBI, FTC, Europol, etc.
- Yes
- No
Did you report your crime to any of these?(Required)
- FBI - Federal Bureau of Investigation
- FTC - Federal Trade Commission
- U.S. Secret Service
- U.S. Postal Inspectors
- Europol
- Interpol
- ActionFraud UK
- Other National Police
- None
Any Additional Information About Your Scam(s) [Optional]
Tell us what you think might be useful so that we can best help you
Your CONTACT with the Criminals
Have you STOPPED All CONTACT with the Scammers?(Required)
Meaning you are not talking, chatting, or emailing with them.
- Yes
- No
- Not Sure
Are you still in contact with the scammer?(Required)
Meaning that you are communicating with the criminals.
- Yes
- No
- Not Sure
How long ago was your LAST CONTACT with the Scammers?(Required)
How many days, weeks, or months?
Have you really Accepted that you are the Victim of a Crime?(Required)
- Yes
- No
- Not Sure
What Support You Are Looking For?
What kind of Support or Help are YOU looking for?(Required)
Please tell us what you are looking for in a support group. What services you would like to receive?
Are YOU Committed to participating in a recovery program?(Required)
- Yes
- No
- Not Sure
Are you seeing a Counselor or Therapist or Psychiatrist?(Required)
Either a Psychologist or Psychiatrist or other Medical Professional about your mental health. A Coach is not the same.
- Yes
- No
Do you think any of the following apply to you?(Required)
We are not trying to diagnose you, just to get a better understanding of how you are doing currently.
- Denial
- Anger
- Depression
- Anxiety
- Fear
- Paranoia
- Thoughts of Harming Yourself
- Unable to Sleep
- None of These
- Something Else
Please tell us a little about your current emotional state or feelings?(Required)
Other Anti-Scam Activities
Are you engaged in any of the following(Required)
- Exposing Scammers
- Scam Baiting
- Deceiving Scammers to get information
- Helping other Victims
- Reporting Scammers to Law Enforcement
- Reporting Scammers to Websites or Apps
- Shaming Scammers
- None of them
- I am not sure
What do you think your knowledge is about scams?(Required)
- I am an expert
- I know a lot about scams
- I have learned some about scams
- I don't know very much about scams
- I know very little about scams
- I am helping other victims
Do you worry about being scammed again?(Required)
- I will never be scammed again
- I don't want it to happen again
- I am not sure how to prevent it happening again
- I think I am at risk of being scammed again
- I am not worried
Are you a member of any other Anti-Scam or Support Groups?(Required)
- Yes
- No
Are you a member of any other Anti-Scam or Support Groups? Please tell us who they are and a little about them? (Optional)
Are you helping other scam victims?(Required)
- Yes
- No
Are you helping other scam victims? Tell us how and where? (Optional)
Are you involved in Scam Baiting?(Required)
- Yes
- No
- Not Sure
Have you hired anyone to investigate your scam or recover your money?(Required)
- Yes
- No
- Not Sure
Mental Healthcare Activities
Are you currently or previously seeing a mental healthcare provider, such as a therapist or counselor?(Required)
Are you seeing a therapist or counselor now?(Required)
- Yes
- No
- Not Sure
Your Commitment
The services that are asking to receive are free of cost, however the SCARS Institute only accepts those that are sincere and committed to their recovery after the scam.
Which statement best describes what you are looking for?(Required)
- I am focused on getting my money back
- I am focused on getting the scammers arrested - I want Justice
- I am focused on returning to my former self and recovering my life
- I am not sure what I am focused on right now
- I am committed to my emotional recovery
- I just want to hear the stories of other scam victims
- I want to expose the scammers that do this to people
- I am very angry at scammers and myself
Do you understand that you are committing to participate in a scam victim recovery program(Required)
Failure to participate regularly in the program may result in your removal from the program.
- I Agree
- I Do Not Agree
Your Consent
Consent(Required)
This SCARS Institute 120 recovery program requires your active participation. You may leave the program at any time and there is no cost. That this is a 4 month program and that after that there will be other options available for those that complete it. If you fail to meet the participation obligation you can be removed from the program. Participation requirements are that: You will participate in the only group several times a week. You will join our private and confidential zoom calls at least twice a month. You will comply with our other rules, terms, and conditions, which will be provided to you.
I agree to the participation requirement.
Consent(Required)
This SCARS Institute service is not a mental healthcare program and may not suitable for all individuals that apply or are initially accepted. If, in our judgement, a member indicates they are suicidal, the SCARS Institute team may contact local law enforcement to assist and support the program member.
I understand this.
Consent(Required)
You are agreeing to conform to our service requirements and rules as published in our support groups and the following:. By submitting a request for our services, you agree to the following: 1) We have the right to accept or reject your request for services or removal from our services at our sole discretion. 2) We will not be liable for any damages of any kind or losses incurred as a result of our rejection of your request for services or removal from those services. 3) If we accept your request for services, we will provide you with written rules that outlines the terms and conditions of our services (in digital form within our support group,) however certain behaviors may fall outside of those rules that may still result in the removal from our services. 4) You agree to abide by the terms and conditions, rules, and policies of our services and hold SCARS harmless for any actions during the use of our services. We reserve the right to modify or terminate our services at any time. 5) You agree to indemnify and hold us harmless from any and all claims, damages, losses, liabilities, costs, and expenses (including reasonable attorneys' fees) arising out of or in connection with your use of our services.
If you have any questions about this disclaimer, please contact us by email at contact@AgainstScams.org. You confirm that you are a real person, using your real name, location, and contact information in your request to join and use our SCARS Scam Victims' Support & Recovery Groups. You are authorizing us to contact you by email, Messenger, or in an emergency or for other concerns by phone.
SCARS will not sell or release to marketers any of this information but may send emails relating to scams and victim support information to you from time to time. By consenting to the above you are agreeing to these terms and also agree to abide by the rules of SCARS' Support Groups as well as the SCARS Code of Conduct (see menu), and such other SCARS policies and standards as may apply. Fraudulent requests will be referred to law enforcement for prosecution.
I agree to these term & conditions, privacy policy, and support group rules.
NOTE: If you click the submit button and nothing happens, scroll up and see if you missed any fields or there are errors.
Thank you for trusting SCARS to help you through your scam recovery and for requesting to join our SCARS Institute 120 Recovery Program. If approved and confirmed, you will receive an email invitation or a message through Facebook or directly with information on how to find and finalize your participation in our program. Sincerely, SCARS Institute Team Miami Florida U.S.A.
Email
This field is for validation purposes and should be left unchanged.

NOTICE

PLEASE NOTE: Membership and Acceptance for SCARS Support Groups is subject to review and is not automatic. We will follow up with you by email and if accepted you will be notified. We reserve the right to reject any applicant.

SCARS Team
Society of Citizens Against Relationship Scams Inc.

Next Things to Learn – the Next Steps

SCARS Institute Resources:

For New Victims of Relationship Scams www.ScamVictimsSupport.org
Learn to recover from scams at www.SCARSeducation.org
Sign up for SCARS Institute professional support & recovery groups, visit support.AgainstScams.org
Find competent trauma counselors or therapists, visit counseling.AgainstScams.org
Become a SCARS Institute Member and get free counseling benefits, visit membership.AgainstScams.org
Report each and every crime, learn how to at reporting.AgainstScams.org
Learn more about Scams & Scammers at RomanceScamsNOW.com and ScamsNOW.com
Scammer photos ScammerPhotos.com
SCARS Institute Videos youtube.AgainstScams.org
SCARS Institute Self-Help Books for Scam Victims are at shop.AgainstScams.org
Donate to SCARS Institute and help us help others at donate.AgainstScams.org
Worldwide Crisis Hotlines: https://blog.opencounseling.com/suicide-hotlines/

SCARS Consent For Support Services Intake Form

Please Note

Join the SCARS Institute 120 Recovery Program for Scam Victim-Survivors

Tell Us About You

Tell Us About What Happened/The Crime

The Following Questions are about the Most Recent Scam

You can add any additional details about past scams, frauds, or cybercrimes in the general fields below

Your CONTACT with the Criminals

What Support You Are Looking For?

Other Anti-Scam Activities

Mental Healthcare Activities

Your Commitment

Your Consent

NOTE: If you click the submit button and nothing happens, scroll up and see if you missed any fields or there are errors.

NOTICE

Next Things to Learn – the Next Steps

SCARS Institute Resources: