Skip to content
Pediatric Bipolar I Depression Study Survey
Please complete this short survey to see if your child qualifies to participate in this study.
1.
Please leave your name, phone number, and email for us to contact you should you qualify for this trial.
Name:
Phone #:
Email:
2.
Is your child between 10 and 17 years old?
Yes
No
3.
Does your child have a diagnosis of bipolar I disorder?
Yes
No
4.
Is your child currently having a depressive episode?
Yes
No
I'm not sure
5.
Has your child ever experienced a manic episode?
Yes
No
I'm not sure
6.
Has your child been diagnosed with schizophrenia, schizoaffective disorder,
schizophreniform disorder, a psychotic disorder due to another medical condition, PTSD, antisocial personality disorder, or borderline personality
disorder?
Yes
No
I'm not sure
7.
Does your child have a history of seizures?
Yes
No
I'm not sure