Salvage Psychiatry Telepsychiatry (Client Safety Contract)

I                                                          hereby contract with Sound Wellness Telepsychiatry Mental Health Provider/Clinician), that I will take the following actions if I feel suicidal…

 

 I will NOT attempt suicide.

 I will call someone. , please provide name and telephone #                                 

 If I do not reach Dr. Linda Allibalogun or my assigned provider, I can either call my therapist or phone any of the following services:

 Names/Agencies:

•  National Suicide Prevention Hotlines 1-800-SUICIDE (784-2433) or 1-800-273-TALK (8255) http://www.aamentalhealth.org/pr_warmline. 410-768-5522

•  Disaster Distress (Helpline Offers Immediate Crisis Counseling) 1-800-985 text "TalkWithUs" to 66746

        1-800-985-5990 or test "Habianos" to 66746 (Spanish)

 I will further seek support from any of the following people: Provide names and phone numbers

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If none of these actions are helpful or not available, I will go to the ER at one of the following: Provide potential Hospital name, Address, and Phone below:

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 If I am unable to get help or I am unable to go to the hospital, I will call 911 and request help.