Self Harm Survey
When are you first learned of the concept of self harm (cutting, etc)?
under 9
9-12
13-15
16-18
I'm not sure what you are referring to?
Other
Where did you learn about self harm/cutting?
Media (book, movie or TV)
Internet
Your Parent
A friend
Other
Have you ever cut on yourself or self harmed in some way?
Yes
No
If you have self harmed, how old were you the first time you cut on yourself?
under 10
10-12
13-15
16-18
18+
Other
Do you have a friend or know of someone in your school who self harms?
Yes
No
What do you want to know more about self harm?
What causes someone to self harm
How to quit self harming
How to talk to your parents about self harm
How to help a friend who self harms
Other
Your Age
Younger than 12
12-17
18-25
26+
What advice would you give to someone self-harming or thinking about self-harming?
Do you want to share a brief story about self-harm that you think would help others?
Name (Optional)
First Name
Last Name
Email (Optional)
example@example.com
Submit
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