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. 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 we will get back to you within 3 working days.

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).

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?*
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? *
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*