1. How old are you ? 2. Have you ever self harm ? 3. How do you self injury? 4. With what do you self harm ? 5. Since when do you self harm ? 6. Do you have any other psychological issue(s) ? 7. Do you tell that your problem(s) to someone ? 8. Do you want to stop cutting ? 9. Do you take care of your wounds ? 10. How often do you self harm ? (Average) 11. Have you ever had suicidal thoughts ? 12. After what do you cut ?