Client Safety Plan
Your Full Name
*
First Name
Last Name
Your email
*
example@example.com
Step 1: Warning Signs (Thought, images, mood situation,behavior) that a crisis may be developing:
*
I have thoughts of bad or uncomfortable situations
I have unwanted or intrusive imagines come to me
My mood becomes bad, anxious, depressed or angry
A situation occurs which causes me anger, anxiety, upset, depression.
I start acting in a negative manner
Other
Step 1: Narrative - Would you please provide additional information
Step 2: Internal Coping Strategies - Things I can do to take my mind off things without contacting another person.
*
Do some relaxation movements (Yoga/stretching/meditation)
Go to the gym, exercise, or take a walk
read, listen to music, watch TV
Step 3A: People I can call and will provide a distraction
*
Step 3B: Places I can go to that will provide a distraction
*
Step 4: First Person I can call for Help.
*
Phone Number of First Person I can Call for Help.
*
Please enter a valid phone number.
Step 4: Second Person I can call for Help.
Phone Number of Second Person I can Call for Help.
Please enter a valid phone number.
Step 4: Third Person I can call for Help.
Phone Number of Third Person I can Call for Help.
Please enter a valid phone number.
Step 5: Professionals or Agencies I can contact during a crisis
*
Step 5: PHONE NUMBER of Professionals or Agencies I can contact during a crisis
*
Please enter a valid phone number.
Step 5: Professionals or Agencies I can contact during a crisis
Step 5: PHONE NUMBER of Professionals or Agencies I can contact during a crisis
Please enter a valid phone number.
Step 5: Local Urgent Care/Emergency Room (Name)
Step 5: Local Urgent Care/Emergency Room (Address)
Step 5: Local Urgent Care/Emergency Room (Phone Number)
Please enter a valid phone number.
Suicide Prevention Lifeline 1-800-273-TALK (8255)
Step 6: What can I do to make my environment safe or safer:
*
The one thing that is most important for me and is worth living for is...
*
Submit
Should be Empty: