SpeakOut MindCheck 💚
Anonymous Reporting Form
If you or someone you know is in danger, please tell a trusted adult or call
112
immediately.
Who is this about?
-- choose one --
Myself
A friend
Someone else
Type of concern
-- choose one --
I feel like hurting myself
Someone is hurting me (bullying, abuse, threats)
I don’t feel safe at home
I’m worried about a friend
Something else
What happened? (please describe briefly)
Where are you (school / community)?
How old are you?
Prefer not to say
Under 13
13–15
16–18
18+
Do you want someone to contact you to help?
-- choose one --
Yes, please reach me
No, keep me anonymous
How can we reach you safely? (optional)
Safe adult (optional)
By submitting, you agree we may share this information with a trusted adult or school contact if someone’s life or safety is in danger.
Submit Report ✅
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