Make a CHAT Referral - CHAT - Community Health Assessment Team

CHAT provides confidential mental health checks for young persons between 16 and 30 years old, who are currently living in Singapore.

This is a conversation with our qualified mental health professionals about your mental health concerns, and how these may have affected your friends/ family/ occupation etc. Your sharing in these aspects is to help us have a better understanding of what’s going on, so as to provide you with appropriate recommendations of professional help based on your needs. Click here if you wish to know more about our CHAT mental health check.

To request for a mental health check, please fill in the form below and click “Next”. As our appointment slots are currently fully subscribed, please click on “I can’t find a convenient slot”. Our mental health professionals will contact you via phone within 5 working days upon receiving your form.

If you are not comfortable speaking on the phone, please reach out to us via our online text-based webCHAT service instead by clicking on the icon in the right column.

CHAT is NOT a counselling or crisis service. If you, or someone you are concerned about, are feeling suicidal and in need of urgent support, please contact Samaritans of Singapore (SOS) at 1800-221-4444. Stay on the phone until someone attends to you. Or, head down to the Accident and Emergency (A&E) Department of the nearest hospital for immediate medical attention. Both operate 24/7.

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).

(We are experiencing technical issues with the form, for best results please use Firefox or Chrome to submit the form. We apologise for any inconvenience caused.)

Name* (of a young person)
Sex*	MaleFemale
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?*	YesNo
How did you know about CHAT?*
Please briefly describe your concerns and how you would like CHAT to help*

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? *
Never It was just a brief passing thought I have had a plan at least once to kill myself but did not try to do it I have had a plan at least once to kill myself and really wanted to die I have attempted to kill myself, but did not want to die I have attempted to kill myself, and really hoped to die


2.	How often have you thought about killing yourself in the past year? *
Never Rarely(1 time) Sometimes(2 times) Often(3-4 times) Very Often(5 or more times)


3.	Have you ever told someone that you were going to commit suicide,or that you might do it? *
No Yes, at one time, but did not really want to die Yes, at one time, and really wanted to die Yes, more than once, but did not want to do it Yes, more than once, and really wanted to do it


4.	How likely is it that you will attempt suicide someday? *
Never No chance at all Rather unlikely Unlikely Likely Rather likely Very likely

In case of an emergency, please contact:
Name*
Relationship to you*
Contact Number*

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:	MyselfYoung Person’s Name* Relationship* Contact Number* Email*