You can always press Enter⏎ to continue
Before we start
Please complete this form accurately and to the best of your knowledge.
3
Questions
START
1
Have you ever self-harmed to the point where you required hospitalisation (being admitted) in the last 12 months?
*
This field is required.
YES
NO
Previous
Next
Submit
Press
Enter
2
Over the last 2 weeks, have you persistently (almost every day) been bothered by thoughts that you would be better off dead or hurting yourself in some way?
*
This field is required.
YES
NO
Previous
Next
Submit
Press
Enter
3
Have you attempted to end your life or intentionally harmed yourself with suicidal intent in the last 12 months?
*
This field is required.
YES
NO
Previous
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
3
See All
Go Back
Submit