Bipolar Depression Study

Pre-qualify for Two Upcoming Research Studies: Bipolar Disorder and Depression
Please provide your first and last name. *

First NameLast Name
Birth Date*

MonthDayYear
Date
How old are you (years of age)*
You must be between the ages of 18-65 to participate.
Mobile Number*
By providing us with your phone number and email, you agree to receive communication from Clinilabs. You may opt out at any time.
Email*
example@example.com
Are you able to attend study visits in the following locations?*

Bipolar disorder in Midtown Manhattan, NYCDepression in Eatontown, NJ
Do you have a diagnosis of bipolar disorder?*

YesNo
Do you have a diagnosis of depression?*

YesNo
Who diagnosed you? *
Are you on medication for bipolar disorder?*

YesNo
Are you on medication for depression?*

YesNo
Are you currently taking or have you taken at least 2 antidepressants?*

YesNo
Does medication help with your depressive symptoms?*

YesNo
Do you consume THC products?*

YesNo
If yes to the above, when was the last time you consumed a THC product?*
Do your symptoms get in the way of your daily activities?*

YesNo
Have you felt sad in the past 2 weeks?*

YesNo
How many hours do you sleep per night? *
What is your energy level like? *
Any changes in appetite? *
When was the last time you experienced a manic or hypomanic episode? *
Tell us a bit more about yourself. Please list any medical conditions and medications you may be taking (including dosage). We would also love to hear more about your schedule, including the best time/method to reach you, and why you would be interested in participating. *
How did you hear about this research study?*

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Pre-qualify for Two Upcoming Research Studies: Bipolar Disorder and Depression