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C-SSRS Lite

Safety Screening (Suicide Risk)

These questions help us understand if you're safe right now. Please answer honestly — there's no judgment, and what you share helps us help you.

If you are in immediate danger or thinking about ending your life right now, please call or text 988 (Suicide & Crisis Lifeline), or call 911.

1. In the past month, have you wished you were dead or wished you could go to sleep and not wake up?

2. In the past month, have you actually had any thoughts of killing yourself?

3. Have you been thinking about how you might do this?

4. Have you had these thoughts and had some intention of acting on them?

5. Have you started to work out, or worked out, the details of how to kill yourself? Do you intend to carry out this plan?

6. In your lifetime, have you ever done anything, started to do anything, or prepared to do anything to end your life?

Your Information

So we can match this to your chart and follow up.

Submitted securely. Used only for your care.

A-Nu Health · (312) 796-2646 · info@a-nuhealth.com — These responses are informational and reviewed by your provider. Not a diagnosis. If you are in crisis, call or text 988 or call 911.