Have any of the following occurred?

□   Recent thoughts about suicide:

▸    These thoughts can range from fleeting thoughts to a detailed plan for suicide
▸    Examples of suicidal thoughts include: "I wish I was dead" or "I wish I had not been born"

□   A previous attempt to end your life

□   Deliberate and severe harm to yourself:

▸    This could be deliberately hurting your body, where your goal may not be to end your own life

□   A plan to harm others

□   Often hearing or seeing things that other people do not seem hear or see

□   Currently experiencing high levels of distress

□   A recent significant life event? For example:

▸    Death of a loved one
▸    A difficult relationship separation
▸    Crime or legal life events (For example: being the victim of an assault, being accused of a crime, being arrested, or being involved in a court case)
▸    A significant personal injury or illness
▸    A major life transition that has been difficult to manage (For example: retirement, job loss, relocation)

« Back Yes, I think so No, not for a long time No, never