Fill out the form below to see if you qualify.
Have you ever been diagnosed with Bipolar Disorder?
Yes No Not sure
If yes, what type?
---Bipolar Disorder IBipolar Disorder IINot sure
Are you currently experiencing a depressive episode?
If yes, how long has this CURRENT period of depression been going on?
---Less than 2 weeksAbout a monthA few monthsMore than 6 months
When was the last time you had a manic episode (brief period of hyperactivity)?
Currently Within the past month A couple months ago 4+ months ago
Have you ever attempted suicide?
-If you answered yes, when was the last time you attempted suicide?
How did you hear about us? (required)
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