SIDAS form - Country & Outback Health

Suicidal Ideation Attributes
Scale (SIDAS) form

Please complete all information required in the form fields below

Suicidal Ideation Attributes Scale (SIDAS) Form

Full Name *

Date of Birth *

Address
Address Line 1
City
State / Province / Region
Postal Code
This service is only available within South Australia. Check our services page for specific locations. Or contact Head to Health directly on 1800 595 212 or visit website www.headtohealth.gov.au for alternative services in their area.

The following five questions ask about how you have been feeling in the past month. For each question, circle the number under the option that best describes the amount of time you felt that way.

	0	1	2	3	4	5	6	7	8	9	10
	00	11	22	33	44	55	66	77	88	99	1010

	0	1	2	3	4	5	6	7	8	9	10
	00	11	22	33	44	55	66	77	88	99	1010

	0	1	2	3	4	5	6	7	8	9	10
	00	11	22	33	44	55	66	77	88	99	1010

	0	1	2	3	4	5	6	7	8	9	10
	00	11	22	33	44	55	66	77	88	99	1010

In the past month, how much have thoughts about suicide interfered with your ability to carry out daily activities, such as work, household tasks or social activities? (0 = Not at all, 10 = Extremely)

0 1 2 3 4 5 6 7 8 9 10

00
11
22
33
44
55
66
77
88
99
1010

	0	1	2	3	4	5	6	7	8	9	10
	00	11	22	33	44	55	66	77	88	99	1010

Date

Message

Suicidal Ideation Attributes Scale (SIDAS) form

Suicidal Ideation Attributes Scale (SIDAS) Form

The following five questions ask about how you have been feeling in the past month. For each question, circle the number under the option that best describes the amount of time you felt that way.

Suicidal Ideation Attributes
Scale (SIDAS) form