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?
    YesNoNot sure

    If yes, what type?

    ​Are you currently experiencing a depressive episode?

    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?

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

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