Bipolar Disorder

Interested in participating in a bipolar disorder study?

Fill out the form below to see if you qualify.

    First Name*

    Last Name*

    Email*

    Phone Number*


    Have you ever been diagnosed with Bipolar Disorder?
    YesNoNot sure


    If yes, what type?


    ​Are you currently experiencing a depressive episode?
    yesno


    If yes, how long has this CURRENT period of depression been going on?


    ​When was the last time you had a manic episode (period of hyperactivity lasting 3 or more days)?
    CurrentlyWithin the past monthA couple months ago4+ months ago


    Have you ever attempted suicide?
    yesno


    ​​-If you answered yes, when was the last time you attempted suicide?


    Comments are closed.