Integrated Primary Care Course Interest Form

Integrated Primary Care Course Interest Form

  • Please provide the following: Name/Degree, Title/Position, Institution, Mailing Address (with Street, City, State, Zip Code), Phone Number, and Email Address
  • Type of Program:
  • APA Accredited?
  • Does your program offer clinical experience in a primary care setting?
  • How much experience do you have in primary care?
  • How will you be using the materials?
  • Please provide the following: Name/Degree, Status (Graduate Student, MA, Psy.D, Ph.D, Intern, or Post-Doctoral Trainee), Is your program APA accredited?, Institution, Mailing Address (Street, City, State, Zip Code), Phone Number, and Email Address
  • What primary care learning experiences are offered in your training program (all that apply)?
  • How will you use the materials?
  • Please provide the following: Name/Degree, Mailing Address (Street, City, State, Zip Code),Phone Number, Email Address, and Practice Type (Independent practice, Multidisciplinary Behavioral Health Practice, Hospital/Non-Primary Care Healthcare Setting, Primary Care, or Other (specify))
  • How will you use the materials?
  • How much experience do have in primary care?
  • Was your primary care experience during (select all that apply):
  • 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.
  • This field is for validation purposes and should be left unchanged.

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