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Bipolar Screening

Please answer each question to the best of your ability.

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1. Has there ever been a period of time when you were not your usual self and...

Like being unable to work; having family, money or legal troubles; getting into arguments or fights?
i.e. Children, siblings, parents, grandparents, aunts, and uncles.

Survey Questions
Before you get to your results, please take a moment to answer the following optional questions. If you aren’t comfortable sharing any or all of the information, you can click “submit” right away. Otherwise, your answers will help us better understand how we can achieve our mission. Don’t worry; we won’t be able to identify you based on this information.
Please note that we cannot respond if you entered “other.” If you are in crisis, please call 911 or the National Suicide Prevention Hotline at 1-800-273-TALK or go immediately to the nearest emergency room.

2000 N. Beauregard Street,
6th Floor Alexandria, VA 22311

Phone (703) 684.7722

Toll Free (800) 969.6642

Fax (703) 684.5968

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