Suicide Protocol

These guidelines are intended to assist the clinician with addressing the clients related crisis who by signing below provides their consent to release information for this session / purpose only.
Client Name*
First Last
Please Select Your Therapist*
Date*
MM slash DD slash YYYY
Are you willing to sit with the individual for 24 hours to assure safety?*
Are you willing to sit with the individual until emergency personnel arrive?*
Are you willing to take the individual to the hospital for an evaluation?*
What are the warning signs that indicate the individual is decompensating?*
Are there any weapons in the individual's residence?*
If there are weapons, are you willing to remove them?*
Are there any lethal medication in the individual's residence?*
If there are lethal medications, are you willing to secure and lock the medication?*
CAPTCHA
Client Signature*
First Last
Typing your name here serves as your electronic signature.
Therapist Signature
First Last
Typing your name here serves as your electronic signature.
Witness Signature*
First Last
Typing your name here serves as your electronic signature.