Wufoo
No Self Harm Contract
This form is for those who would like to commit to not self harming. Accountability can be a powerful tool in overcoming self harm. By filling out this form you are making a commitment to not self harm for the period of time that you choose. I encourage you to make the time period challenging and work for it so that you will continue to be self harm free. It's time to break the hold self harm has on you!! It's controlled your life long enough. Please provide us with your name and email so that we can pray for and encourage you.
Name
First
Last
Email
*
Though I feel like self harming, I understand self harm is not a good way to cope and I commit to not performing any type of self harm behavior for at least 3 hours.
Yes
No
How long are you willing to commit to not self harming?
3 hours
6 hours
12 hours
24 hours
>One week
Do Not Fill This Out
Wufoo
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