Address __________________________

Telephone ________________________

Name (Contractor)

Address ___________________________

Telephone ___________________________

, _______________________________ 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 contractor’s judgement knowing that if i am ill my own judgement 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




Contractor ____________________________


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