Bipolar Help Contract

Between
and
 
__________________________________

Name

Address  __________________________

__________________________________

__________________________________

Telephone  ________________________

___________________________________

Name (Contractor)

Address  ___________________________

___________________________________

___________________________________

Telephone ___________________________


I, _______________________________ realize and acknowledge that the contractor (above) is able to recognize signs of my illness (Bipolar Disorder), whether they are signs of mania or depression.  If in his/her opinion my illness seems to impede on my normal day to day functioning I will trust the contractors judgment knowing that if i am ill my own judgment is frequently impaired.  I promise to follow his/her directions regarding the seeking of treatment for my illness.

This Bipolar Help Contract entitles the contractor:

  • to tell me if he/she thinks that I am ill
  • to suggest I contact a doctor, psychiatrist or psychiatric unit
  • to contact a doctor, psychiatrist, or hospital in order that
    psychiatric help be provided to me.

At no time shall I reproach or become angry with the contractor for fulfilling the terms of this contract.  In return for his/her efforts I pledge my gratitude and friendship.

_________________________________

Individual with Bipolar Disorder

_______________________

Date  

__________________________________

Contractor

 


Bipolar World   1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014
Owners:  Allie Bloom, David Schafer, M.Ed. (Blackdog)

Partners:  John Haeckel, Judith (Duff)
Founder:  Colleen Sullivan
Email Us at Bipolar World


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