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Crisis and Safety Planning

Safety Plan

Below is a template of a Safety Plan. You can also download a fillable PDF version of the Safety Plan to keep on your computer or phone ready for immediate use.

Contact Information

Name Email Mobile Ph. Office Ph. Home Ph.
Patient




Family Contact




 

Health Care Professionals 

Name Phone Email/Address
Psychiatrist


Therapist


HD Physician


Social Worker


 

People to call for help 

Name Phone Email/Address
Neighbor


Family Member


Friend


Other


 

Strategies

Strategies to keep the home environment safe:
1
2
3

Strategies to de-escalate a tense situation:
1
2
3

Items I need to have with me if I leave:
1
2
3

Things the person with HD might need:
1
2
3

Emergency contacts for children:
1
2
3

Emergency Resources

Call 911 

  1. Ask for CIT Trained Officer 

  2. Explain the person has Huntington’s disease and request to send the “Information for First Responders” 

    • Mobile Crisis Service phone# ________________________ 

    • Local Crisis Center phone # _________________________

    • Other phone # ____________________________________ 

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