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The Online Help Form  
Below you will find the Terminal Assist Self Help Form. To receive online help for your problem/issue, just fillout the form in its entirety and hit the "Help Me!" button when you are finished!
I am experiencing the following type of problem :


I have had this problem for :
 A few days
 A few weeks
 A few months
 A few years

I am a :
 Male
 Female

A brief summary of my problem :


I have contemplated suicide :
 Yes
 No

I have attempted suicide :
 Yes
 No

   
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This is your standard disclaimer! This ain't real, dude! Get a life and stop wanting to kill yourself! Gawd!

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