I promise not to commit suicide when I have thoughts of harming myself and to follow the plan below. I prepared this crisis plan together with my psychologist .

1.I agree to call the following people by phone when I have thoughts of harming myself.

(Please fill in by writing at least one name.)

1. Name and Surname of first degree relative:
2. Name and Surname of first degree relative:
3. Name and Surname of a relative or friend:

2.If I still have thoughts of harming myself, I agree to go to one of the places listed below.

(Please fill in with at least one place name.)

1. Somewhere near your house:
2. Somewhere near your work or school:
3. A favorite place:

3.If I still have thoughts of harming myself, I agree to go to the Emergency Service of the nearest hospital.