COMPTE GRATUIT

Bipolar Survey Questions + Sample Questionnaire Template

Bipolar survey template consists of questions that help a medical professional understand whether an individual is showing symptoms of bipolar disorder. This is a self-explanatory questionnaire that even an individual can use to analyze his/her state of mind. This sample survey template can be customized and a number of questions can be added to suit the need of the researcher.

Bipolar disorder is a brain disorder that results in unusual shifts in moods, activity level, quality of work, sleeping pattern and more. An individual who is experiencing bipolar disorder can be extremely happy at one moment and extremely sad the next second. The variations are extreme and irrational. Timely and proper diagnosis can help get treatment in time and lead to a healthy and productive life.


1. Please select your gender
2. Please select your age
3. Please select your ethnicity
4. Please select the most appropriate answer
Never
Rarely
Sometimes
Often
Very Often
At times I am much more talkative than usual
At times I am much more active than usual
I get into a mood where I feel jumpy and irritated
There are times when I have felt happy and sad at the same time
My self-confidence ranges from great to self-doubt to overconfidence all at the same time
In recent times there has been great variation in the quality and standard of my work
For no specific reasons I get angry and hostile
At times I am mentally dull and other times I am quick and sharp
I constantly keep forgetting names, words, places, locations etc.
At times I am greatly interested in being around people and other times I want to be left alone
5. Over the last 3 weeks, how often have you been bothered by the following:
Not at all
Several days
More than half the days
Nearly everyday
No interest or pleasure in doing things
Trouble falling asleep, staying asleep or sleeping way too much
Feeling tired or having very little energy
Eating too less or eating way too much
Trouble concentrating on things, such as reading, watching television etc.
Thoughts of hurting yourself or harming yourself in any way