SBQ-R Suicide Behaviors Questionnaire-Revised

Choices Mental Health Counseling PLLC

Narrowsburg, NY 12764
Suicide Behaviors Questionnaire-Revised

(SBQ-R)
Your Name*
Email*
example@example.com
Today's Date*

MonthDayYear
Date
Instructions: Please check the statement or phrase that best applies to you.
1. Have you ever thought about or attempted to kill yourself? (check one only)

1. Never2. It was just a brief passing thought3a. I have had a plan at least once to kill myself but did not try to do it3b. I have had a plan at least once to kill myself and really wanted to die4a. I have attempted to kill myself, but did not want to die4b. I have attempted to kill myself, and really hoped to die
2. How often have you thought about killing yourself in the past year? (check one only)

1. Never2. Rarely (1 time)3. Sometimes (2 times)4. Often (3-4 times)5. Very Often (5 or more times)
3. Have you ever told someone that you were going to commit suicide, or that you might do it? (check one only)

1. No2a. Yes, at one time, but did not really want to die2b. Yes, at one time, and really wanted to die3a. Yes, more than once, but did not want to do it3b. Yes, more than once, and really wanted to do it
4. How likely is it that you will attempt suicide someday? (check one only)

1. No chance at all2. Rather unlikely3. Unlikely4. Likely5. Rather likely6. Very likely
Please note: Your answers on this form may not be seen immediately. If you are having suicidal thoughts NOW, please call the National Suicide Prevention Hotline at 800-273-8255. Thank you.
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Choices Mental Health Counseling PLLC

Suicide Behaviors Questionnaire-Revised