American Psychiatric Association Publishing
 

Please allow up to 4 weeks for processing. Requests will be processed in the order that they are received.


 

SECTION I. Contact information:

* Name of requestor:   
Name of company or organization:
* Address line 1:  
Address line 2:
Address line 3:
* City:  
State:
Postal code:
* Country:  
* E-mail address for contact person (MUST be valid):   
Telephone number: 
Fax number: 
Are you the author of the material you are requesting to reproduce?
Are you a member of the American Psychiatric Association?

SECTION II. Bill to information:

If you would like your invoice to be addressed to a different recipient, please enter the information here:

Name of company or organization:
Attention to:
Address line 1:
Address line 2:
Address line 3:
City:
State:
Postal code:
Country:

SECTION III. Permission request to republish content:

Part 1. American Psychiatric Association Publishing content to be republished:
Journals:
Journal name: 
Year, Volume, and Issue:
Article title:
Author of the article:
Sections, figures, tables, or images to be reproduced (List and specify page numbers): 
Are you requesting the use of entire article?
Books (including the DSM-5):
Book title: 
Author:
Year published:
Sections, figures, tables, or images to be reproduced (List and specify page numbers): 
For DSM-5 criteria requests (List criteria and page numbers):
For DSM-5 requests:
  • Uses needed, from the list below, must be clearly stated in the request. No blanket or derivative rights will be granted.
  • A document must be attached to the online permissions request form showing the content as it will be reproduced in your publication. The reproduced DSM material must match the source exactly, with the exception of style and format.
  • Each table must show the copyright notice: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (Copyright 2013). American Psychiatric Association.
  • Please note that for DSM-5 requests, we will only grant up to 50% of the total number of diagnostic criteria in the book.

Part 2. Description of your proposed product that will include American Psychiatric Association Publishing content:

Your product type:  















Name of your product:
Author (If applicable):
Publisher or distribution company:
Number of copies to print:
Unit retail price and price structure (Please specify: one-time fee for unlimited use, subscription-based fee, user-based fee, access-based fee, or other fee type):
Is your product a printed publication, or an electronic product, or both?
In which countries will your product be distributed?

Please provide a general description of your proposed product (Description is limited to 1,000 characters):

Please attach a document showing how our material will be displayed in your publication (File limit is 2.5MB): Attachment:
Types of rights you are requesting:











SECTION IV. Permission request to use the Structured Clinical Interview for DSM-5 (SCID-5):
SCID product to be licensed:

Title of the clinical trial, research study, or training course:
Start date of the clinical trial, research study, or training course:
End date of the clinical trial, research study, or training course:
Number of subjects:
Number of times the instrument will be administered to each subject:
Number of administrators/interviewers:
Number of copies that will be distributed:
Interview:
User’s Guide:
Type of use




For SCID-5-CT (Clinical Trials) requests only: Will you require specialized customization of the file to match the inclusion/exclusion criteria for your clinical trial?
For SCID-5-RV (Research Version) requests only: Electronic file option:


SECTION V. License request to include DSM-5 content in electronic software and/or electronic health record:
This section is for requests to license Diagnostic and Statistical Manual of Mental Disorders (DSM) material in an electronic health record or other specialized medical or billing software product. Reproduction of DSM alone is not permitted. Licensed product must contain value-added information.
Name of your product:
General description of your product:
Estimated number of users per year:
Price structure (Please specify: one-time fee for unlimited use, subscription-based fee, user-based fee, access-based fee, or other fee type):
Price:
Type of access and access restriction:
Material to be licensed

SECTION VI. Acknowledgements and signature:

I acknowledge that submission of this request for permission or receipt of a permission fee quote does not constitute permission and that any use of any copyrighted text or images owned by American Psychiatric Association and American Psychiatric Association Publishing is unauthorized unless and until I am in receipt of a signed permission letter, electronic product license agreement, or e-mail.

I further acknowledge that my proposed use may be such that I may be required to enter into an electronic product license agreement in American Psychiatric Association and American Psychiatric Association Publishing’s sole discretion.

I further acknowledge that if any usage or administrative fees are assessed by American Psychiatric Association and American Psychiatric Association Publishing, the signed permission may be withheld until such fees are paid.

Please ensure that the form is completed in its entirety. Incomplete forms may delay processing of your request.

Types of uses that are not granted:
  • Use of material in applications for mobile devices such as iPad, iPod, iPhone, Android, BlackBerry, and any other devices
  • Use of DSM material in self-diagnosis
  • Use of DSM trademark
  • Reproduction of American Psychiatric Association and American Psychiatric Publishing logos
  • Reproduction of entire DSM content in another publication or product
        Agree         Disagree






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