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Harkavy Asnis Suicide Survey - v2

Page One

1. Name *This question is required.

2. Email *This question is required. This question requires a valid email address.

3. How often have you -

Space Cell	Never	Once	1 - 2 times per week	3 - 4 times per week	Daily
Thought you would be better dead
Dreamed about death
Had ideas about killing yourself
Thought that the world would be better off without you
Thought about death and dying
Smoked marijuana
Been in high places and thought about jumping
Thought about ways to kill yourself
Taken drugs other than prescription drugs
Gotten so discouraged that you thought about ending your life
Felt like running into traffic
Had a plan of how you would kill yourself
Wished you were dead
Felt life was not worth living
Drank alcoholic beverages
Thought about killing yourself but did not try it
Tried to kill yourself
Dreamed about killing yourself
Talked to someone about killing yourself
Had a plan to kill yourself, started to do it and then stopped at the last moment
Smoked cigarettes