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Free Bipolar Disorder 101 Call

Join Julie A. Fast, bestselling author of Loving Someone with Bipolar Disorder, Take Charge of Bipolar Disorder and Get it Done When You’re Depressed as she takes you through the symptoms of bipolar disorder from mania and depression to everything in between.  You don’t want to miss this...

Julie A. Fast

Intake Form

Family Coaching Intake Form

Please read the previous page before filling out this intake form.

All information is strictly confidential.

First Name:

Last Name:

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Relationship to the person with bipolar disorder (i.e., partner, parent, friend, etc.):

Name of loved one:

Age of loved one:

When was your loved one diagnosed with bipolar disorder?

Briefly describe your situation with your loved one:

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