Should our chat session end unexpectedly, is there an email address or phone number we may reach you at?
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Contact Info
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How upset are you? [Scale of 1–5] *
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What is your main concern? *
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Other, please specify
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Do you have thoughts of suicide? *
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Age *
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Gender *
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How did you find out about Crisis Chat? *
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Other, please specify
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Race – How do you identify yourself? *
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Ethnicity *
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Some visitors that use chat services may have thoughts of suicide. If this is true for you, please complete the next six questions and then wait for the next available chat specialist.
If you are not having thoughts of suicide, please skip the next six questions and wait for the next available chat specialist.
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1. I am having thoughts about suicide, but I have…
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2. I am having thoughts about suicide, but I have these thoughts...
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3. I am having thoughts about suicide, but I am...
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4. I am having thoughts about suicide, but I am...
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5. I am having thoughts about suicide, but I am...
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6. Is this the first time you have contacted this crisis chat line?
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