Make a CHAT Referral

  • CHAT provides confidential mental health checks for young persons between 16 and 30 years old, who are currently living in Singapore. Through the mental health check with our qualified mental health professionals, you could gain an understanding of your experience and mental wellbeing, and get the help that you need.

    If you would like to make an appointment with CHAT, please fill up the following form and select a time you are able to attend the mental health check with us. In the event you are not able to find a convenient slot, please consider visiting our webCHAT from Tuesdays to Fridays, 1pm to 8pm (excluding public holidays).

    If you are currently feeling suicidal, please seek immediate help by:
    Calling 999 or the Samaritans of Singapore (SOS) at 1800-221-4444 (Both operate 24/7). Stay on the phone with them until someone comes to you. Or, head down to the Accident & Emergency (A&E) Department of the nearest hospital.

    If you had previously made appointment(s) under For Someone I know, you may click here to receive an email with the list of upcoming appointment(s).

STEP 1 OF 2

For Myself
For Someone I know
Section A: About Yourself
Name*
(of a young person)
Sex*
Year of Birth*
Contact Number*
Email Address*
(For receiving CHAT email)
Have you received help from a psychiatrist in the past one year and/or are you currently waiting for a psychiatric appointment elsewhere?*
How did you know about CHAT?*
How would you like CHAT to help you?*
To help us support you better, we would like to have some information about your personal safety.
Please select the statement or phrase that best applies to you:
1. Have you ever thought about or attempted to kill yourself? *






2. How often have you thought about killing yourself in the past year? *





3. Have you ever told someone that you were going to commit suicide,or that you might do it? *





4. How likely is it that you will attempt suicide someday? *







Section B: General Information
In case of an emergency, please contact:
Name*
Relationship to you*
Contact Number*
I recognise that CHAT is dedicating their time and resources to help me understand my mental health concerns better.

In any case that I am unable to come for the appointment, I will inform CHAT the soonest so that the slot can be freed for other young people.

* I have read the above terms and I wish to proceed with this booking.
 

* Mandatory Fields

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Section A: Referrer's Details
How are you related to the young person? *
Your name*
Contact Number*
Email Address*
(For receiving CHAT email)
How did you know about CHAT?*
Tell us more about the young person’s concerns and how would you like CHAT to help?*
In case of an emergency, please contact:
Section B: About Young Person
Name*
(of young person)
Sex*
Year of Birth*
Contact Number*
Email Address*
1. Is the young person aware of this referral to CHAT? *
2. Has the young person received help from a psychiatrist in the past one year and/or is he/she currently waiting for a psychiatric appointment elsewhere? *
3. Has the young person attempted to end his/her life over the past two weeks? *
4. Do you worry that the young person may end his/her life anytime soon? *
Any other information
I recognise that CHAT is dedicating their time and resources to help this young person understand his/her mental health concerns better.

In any case that I know the young person is unable to come for the appointment, I will inform CHAT the soonest so that the slot can be freed for other young people.

* I have read the above terms and I wish to proceed with this booking.
 

* Mandatory Fields

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