Suicidal Tendency Grading Survey

Url

I am a *

Male Female Third gender

Age *

My contact details *

Phone Number

Place I live *

Marital status *

Married Unmarried Never Married Widow(er)

Occupational status that best describes me *

Working Student Unemployed

In the past : I have attempted to end my life *

YES NO

In the last week : Have you felt helpless or hopeless about the situation you are in? *

YES NO

Have you felt that life is not worth living? *

YES NO

Have you had thoughts of harming yourself? *

YES NO

How often have you had thoughts to harm yourself? *

Just a fleeting thought

A few times (more than once in a week)

Frequently (almost daily)

Constantly (constantly preoccupied with the thoughts)

Are you thinking of suicide? *

YES NO

How often do you have thoughts to kill yourself?

Just a fleeting thought

A few times (more than once in a week)

Frequently

Constantly (constantly preoccupied with the thoughts)

Address

SUSHEG CHARITABLE TRUST (REGD.)
34-1 MANJANAKATTE POST
KOMPADAVU MANGALORE TALUK
PIN 574144

+91 96865 58535
+91 96328 49058
+91 94498 30186