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?
 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?


Comments are closed.