Jump to Content
 

Available Forms

NO SUICIDE CONTRACT

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 (please list names, phone numbers, addresses, and any other relevant contact information below):

A. Dr. Evans DNP, PMHNP-BC, GNP-BC Google VOICE Phone Number: (984) 377-3386

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

* Required field