Online Inmate Mental Health Concern
Inmate Name
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First Name
Last Name
Inmate Date of Birth
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Month
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Day
Year
Date
If they have communicated any thoughts of self-harm or ideations of suicide in the last 48 hours, please contact the jail at 512-854-9889.
Is there any history or safety concerns of self-harm or suicide attempts?
Is there any history of self-harm or suicide attempts? Please be as specific as possible, including dates and aftercare if known.
What mental health concerns do you have for the above inmate? For example, has he/she been depressed, anxious, not sleeping or doing odd things recently?
Does he/she take medications for a mental health condition? If yes, what name, dosage and pharmacy?
Do you know if he/she has been drinking excessively, using drugs or abusing prescription pills? If yes, what and how frequently?
Contact Information
Your Name
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First Name
Last Name
Phone Number
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Please enter a valid phone number.
Email
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example@example.com
Relationship to Inmate
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