Integrated Primary Care Course Interest Form

Integrated Primary Care Course Interest Form

Faculty/Clinical Supervisor Specific Information

Student Specific Information

Practicing Psychologist Specific Information

Mailing Address

Contact Information

Faculty/Clinical Supervisor Questions

(Check all that apply)

Student Specific Questions

What primary care learning experiences are offered in your training program (select all that apply)?

Practicing Psychologist Specific Questions

During which of the following was your primary care experience (select all that apply):

Terms of Agreement

Copyright © 2021 Society for Health Psychology, Division 38 of the American Psychological Association. All rights reserved. I am requesting access to the Integrated Primary Care curriculum as a faculty member of a university graduate program, a clinical supervisor of psychology graduate students in a practicum, internship, or postdoctoral training program, a psychology graduate student (at any level of training), or a licensed psychologist. My intention is to use the curriculum to train my students or for self-study. Materials and resources contained within may not be reproduced, modified, distributed, stored, transmitted, published, or broadcast in any manner without prior written permission. Trademarks, or copyright or other notices, may not be removed from copies of the content. No part of the content (text, image, or video) may be used for any purpose other than the educational terms under which permission was given. Use of content for any commercial purpose is explicitly prohibited. The modules contained within the curriculum are to be distributed to students in ‘READ ONLY’ format. By using these resources, in whole or part, you signify your agreement to all terms, conditions, and notices contained or referenced herein. We reserve the right, at our sole discretion, to update or revise these terms of use. General inquiries regarding terms of use should be directed to the Society for Health Psychology administrative office, accessible from this link.

Please Confirm the Terms of Agreement