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.

    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). 

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?*
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? *






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

Next >
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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