'Secrets
No More" Survey
 Have
you every seriously considered suicide? Have you ever
actually attempted suicide? Have you lost someone important
to you to suicide? Do you know someone who has attempted
suicide? Can you think of anyone you know who might be
considering suicide? Note all of this on this Survey Form,
especially the feelings as they come up.
- Each video is approximately five
minutes long.
- Start the stop watch when you
start the first video.
- Automatically click on the next
video and continue the process.
- Look at each person's face and
read as much of the information about the person as you
can.
- Note on the survey form the time
on the stop watch:
- When you first
teared
- When you first
whimpered
- When you first cried out
loud
- When you first
wailed
- When you were moved to find out
what you can do to help achieve Zero
Attempts
- Record the time when you
stopped watching. Close your eyes and take some time
to feel what's going on for you. Journal any
particular feeling, memories, thoughts, as they come
up.
- If you didn't complete the series
of videos and choose to continue after a break, start the
stop watch and continue recording your process. (Use
additional sheets of paper, if needed.)
The
stigma around taking about suicide is one of the things take
keeps suicide hidden and keeps people who are in crisis
afraid to reveal their status. In an effort to reduce that
stigma at some level, we would like to post your story. If
you are open to that, you could remain anonymous, in which
case, If you include your name and contact information, know
that I am the only person who will ever see it. If
it's okay to publish your name, however, let us
know.
Please
send a copy of your completed survey, with your age, gender,
age that you may have seriously considered suicide, age if
you actually attempted and by what means.
Send the survey to Gordon Clay via email
at gordonclay@aol.com
or snail mail at PO Box 12, Brookings, OR 97415
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Trigger
Warning
The content
displayed on this web page may be sensitive to some
viewers. Viewing is not advised if you may become
easily triggered.
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Secrets No More
Survey
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Sex
(Required)
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Age
(Required)
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eMail (not
required)
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Name (Not
required)
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Date
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First
Considered
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Means
Considered
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Comment (If
any)
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Actually
Attempted
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Means
Considered
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Comment (If
any)
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Most Recent
Consideration
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Means
Considered
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Comment (If
any)
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Time Stamp Journaling
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Time
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Circumstance
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Feelings
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0:00
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Start
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©2007-2023,
www.ZeroAttempts.org/secrets-survey-form.html
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