Bipolar Disorder survey

Disclaimer: This survey will be an anonymous so please answer truthfully.

1.

Have you or someone you know experienced bipolar disorder?

o Yes
o No
o Unsure/possibly

2.
o
o
o
o
o
o
o
o
o
o
o

Please check any of the following derogatory terms that you have used in the past:
Cuckoo
Bananas
Loopy
Wacko
Loony
Nuts
Freak
Crazy
Weirdo
Insane
Psycho

3. If you had to choose two words to describe people with bipolar disorder what would they be?
__________________________________________________________