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Crisis Plan Form

What is something I enjoy doing?

What is one thing I am looking forward to doing?

When I relapse or need to manage my risks, I will…

notice warning signs that I am not doing well. These can be physical, emotional, or behavioral.

As soon as I recognize these warning signs, I will go somewhere I feel safe and try to distract myself.

have distractions I can use (list three).

go somewhere I feel safe.

What are some signs that I need help from others?

Who is an important person in my life?

Who can I reach out to for support? List their names and contact information.

Name

First

Last

Phone Number

Name

First

Last

Phone Number

Name

First

Last

Phone Number

How would I like to be supported?

Crisis Support: Alcohol & Drug Information & Referral Service 1 800 663 1441 Lower Mainland: 604 660 9382

Available to people needing help with any kind of substance abuse issues 24 hours a day.

If I still need more help, I will go to the emergency room at the nearest hospital.

If I can’t get to the hospital safely, I will call 911.

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