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, agree to the following:
I understand that my therapist has a legal, ethical, and professional obligation to take all practical and reasonable measures she/he considers to ensure my safety from suicide and/or self-harm. I agree that this is in my best interest and that I will cooperate with my therapist by providing honest information about any thoughts, desires, or impulses I have to hurt or kill myself.
I agree not to act on any thoughts, desires, or impulses I may have to hurt or kill myself between:
If, at any time, I feel unable to resist any thoughts, desires, or impulses I may have to hurt or kill myself, I agree that rather than act on hurting or killing myself, I will do one or more of the following:
I agree that I will either keep this contract with me, in a location where I can quickly get to it at all times while it is in force, and/or that I will copy down these telephone numbers and keep them with me while this contract is in force.