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Do you have children?
Employment Status with Service
Life Experiences:
The death/loss of a family member or loved one
Marital separation and/or divorce
Infidelity in a relationship
I have been in a relationship where there was physical, verbal or emotional abuse
Miscarriage, stillborn or other traumatic pregnancy complication
I have supported my spouse/significant other through a critical incident
I have attempted suicide in the past
I have lost a loved one or close friend due to suicide
I can understand why a person may feel suicidal when the pain they are experiencing becomes overwhelming
I have struggled with an addiction (ie: alcohol, drugs, sex, etc.)
I have struggled with compulsive behavior (ie: gambling, hoarding, shopping, etc.)
I have been in a relationship where my significant other struggled with an addiction
I have been in a relationship where my significant other struggled with compulsive behavior (ie: gambling, hoarding, shopping, etc.)
I am currently seeking mental health care (ie: counselling, mediation, etc.)
I have accessed mental health care in the past (ie: counselling,mediation, etc.)
I am comfortable/willing to discuss and provide referrals and information on abortion
I have been convicted of an indictable offense
I have a health condition that can be made worse with stress
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