Suicide Prevention, Education and Counselling (SPEAC) Form Request for Consultation for Professionals This form is used by professionals to refer young people who have made or are at risk of a suicide attempt. * required fields Referring Professional First name Last name Community agency or institution Phone number Preferred time to call Email address Person Being Referred Age School Community of residence - Select -SurreyWhite RockLangleyOther Please provide a brief summary of why you would like to talk with a clinician Submit