, 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, or harming others. 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, or anyone else.

I agree not to act on any thoughts, desires, or impulses I may have to hurt or kill myself, or anyone else, 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:

• Chat with someone: https://suicidepreventionlifeline.org/chat/
• Text “Home” to 741741 and you can chat over text with counselor.
• Call 911 and tell the operator that I am thinking about hurting or killing myself

• If I am unable to reach my therapist, I will call the Cherry Hill Twin Oaks Crisis Center at (856) 428-4357
• If I am unable to reach the Hotline, I will call the National Suicide Prevention Lifeline at 1-800-273-8255 or chat online http://chat.suicidepreventionlifeline.org/GetHelp/LifelineChat.aspx
• I will physically take myself to the emergency room of Kennedy Hospital Cherry Hill or the closest emergency room and tell the staff that I am thinking of hurting or killing myself or someone else.

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.