Bipolar Disorder - Inpatient Treatment

CN012-0036 Clinical Study

Pre-screening - please select your answers

Survey

Selecting an answer means Yes,
leaving the answer unchecked means No.

Are you between 18-65 years of age (inclusive)?

Do you have a diagnosis of bipolar I disorder?

Are you currently experiencing symptoms of mania?

Do you have any other psychiatric diagnoses?

Contact details

Full name *

Phone *

E-mail *

Age *

City *

Additional informations (optional)

I consent to being contacted by phone and email for the purpose of receiving information about the clinical study and completing the pre-screening process.

I have read the privacy notice regarding the processing of personal data.

M2M Med
ul. Lwowska 34
41-500 Chorzów

Godziny otwarcia:

Poniedziałek - Piątek: 08:00 - 20:00
Sobota: 09:00 - 13:00

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