NO SUICIDE CONTRACT
I hereby agree that I will not harm myself in any way, attempt suicide, or die by suicide.
Furthermore, I agree that I will take the following actions if I am ever suicidal:1) I will remind myself that I can never, under any circumstances, harm myself in any way, attempt suicide, or die by suicide.
2) I will call 911 if I believe that I am in immediate danger of harming myself.
3) I will call any or all of the following numbers if I am not in immediate danger of harming myself but have suicidal thoughts: 1) Dr. Henrietta Evans DNP RN PMHNP-BC, GNP-BC 984-377-3386; 2) Keilah Ford DNP (s), MSN, RN, PMHNP-BC, FNP-C 984-377-3393, and 1-800-SUICIDE, 832-879-2107.
A. Text my provider or call this Phone Number 1) Dr. Henrietta Evans DNP RN PMHNP-BC, GNP-BC 984-377-3386; 2) Keilah Ford DNP (s), MSN, RN, PMHNP-BC, FNP-C 984-377-3393
B. 1-800-SUICIDE -- 24-hour suicide prevention line that can be called from anywhere in the U.S.
4) I will TEXT "I'M ALIVE" three times a day to ensure that I am safe to the Google Voice number. I will continue to talk on the phone with as many people as necessary for as long as necessary until the suicidal thoughts have subsided