Bipolar Disorder

Interested in participating in a Bipolar Disorder study?

Fill out the form below to see if you qualify.

First Name*

Last Name*


Phone Number*

Have you ever been diagnosed with Bipolar Disorder?
 Yes No Not sure

If yes, what type?

​Are you currently experiencing a depressive episode?
 yes no

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

​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?
 yes no

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

How did you hear about us? (required)

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