This questionnaire assesses your risk of self-harm and/or suicide.

Have you wished you were dead or wished you could go to sleep and not wake up?
Have you actually had any thoughts of killing yourself?
Have you been thinking about how you might kill yourself?
Have you had these thoughts with intentions of acting on them?
Have you started to work out or worked out the details of how to kill yourself with intention of carrying out this plan?
Have you ever done anything, started to do anything, or prepared to do something to end your life? (such as obtained a gun, collected pills, etc.)
If yes, how long ago did you do any of these?

Please fill out all required fields and click the "Submit" button at the end of the questionnaire. 

Following completion, an email will be sent to you with results and how to follow up.

© 2018 Refined Transitions

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4445 Eastgate Mall Rd #200

San Diego, CA 92121