Thomasian Mental Health Responders: Client Sign-Up Sheet
Thank you for reaching out to the Thomasian Mental Health Responders. Your mental health is important to us.

The Thomasian Mental Health Responders, led by the Association of Thomasian Psychology Alumni together with the UST Department of Psychology, is offering FREE psychosocial support and telecounseling services to the public in this time of heightened anxiety, fear, and stress brought about by the global pandemic of the Corona Virus Disease 2019 (COVID-19).

Our volunteers include Registered Psychologists, Registered Guidance Counselors, and other mental health professionals and volunteers trained in providing psychological first aid and mental health psychosocial support. Depending on the intake information you provide, an appropriate volunteer will be assigned to you.

Kindly fill out this form completely and honestly so that we may be able to provide you with the most appropriate service. All information are held in strict confidentiality and are only used for client-volunteer matching and for getting in touch with you.

For those who need more immediate services, we can refer you to these lines. They have counselors 24/7 and they can hear you out right now.

NCMH Crisis Hotline:
Mobile: (+63) 917 899 8727
Landline: (02) 7989 8727

Hopeline Philippines:
Globe: 2919 (free for Globe and TM)
Globe: (+63) 917 558 4673
Smart: (+63) 918 873 4673
PLDT: (02) 8804 4673
Name: (Last Name, First Name, Middle Initial) *
Nickname: *
You are a ____: *
Age: *
Sex: *
Email Address: *
Mobile Number: *
Mobile Network: *
How do you prefer your session to be conducted? (Click all that applies. The first three are preferred. Our online messaging, video, and voice call are done through Viber / FB messenger***). *
*** If you prefer Facebook Messenger for calls/messaging, please share the link here or state the your FB profile name for our volunteer to reach you accurately .
Reason/s for seeking our services: (Please provide details.) *
Do you have a pre-existing, diagnosed psychological condition? *
*** If yes, what is the diagnosis?
When would be good DAYS and TIMES to get in touch with you? Please indicate all possible days and hours. (ex. Any day between 4:00 pm - 8:00 pm; or Weekends anytime; or MWF - 5:00 pm onwards) *
Please give us one to three days to process and match you with the right mental health volunteer. A volunteer may not be available to attend to you as soon as "today" or "tomorrow." For clients with pre-existing conditions, please note that majority of our registered psychologists and counselors are only available until 7pm.
Is your need for the service urgent? *
Have you had suicidal thoughts in the last 2 weeks? *
*** If yes, please provide a person to contact in case of emergency, their relationship to you, and their contact number. *
We shall contact this person ONLY in case of emergency. We are ethically bound to do so because YOUR LIFE IS VALUABLE. (Write N"/A" if not applicable.)
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