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PsychPRO Information Request

Welcome to PsychPRO, APA's Mental Health Registry

Thank you for contacting us to learn more about PsychPRO, APA's Mental Health Registry. We'd like to ask you to answer a few questions about your practice so we can better determine your needs and how we can be of assistance. Once we receive your inquiry, a member of our team will contact you to schedule a call and a registry demonstration. Please feel free to contact us with any questions at PsychPRO@psych.org.

1. Practice Name *This question is required.

2. Type of Practice: *This question is required.

3. Practice City and State (Ex. Washington, DC): *This question is required.

4. Contact Name: (Ex. Jane Smith) *This question is required.

5. Contact Title: (Ex. Ms., Mr., Dr., etc. ) *This question is required.

6. Contact Email: (Ex. Jane.Smith@gmail.com) *This question is required. This question requires a valid email address.

7. Where did you learn about PsychPRO? *This question is required.

8. What is your primary interest in PsychPRO? *This question is required.

9. If Other Type of Practice, please specify. *This question is required.

9. Do you use an Electronic Health Record (EHR)? *This question is required.

10. Does your practice currently participate in CMS' Merit-based Payment System
(MIPS).

11. What Electronic Health Record do you use? (Ex. EPIC) *This question is required.

11. Does your practice currently have an internal Quality Improvement Initiative?

12. Do you have a Practice Management system (other than your EHR)? (Ex. AthenaHealth) *This question is required.

13. What Practice Management system do you use? *This question is required.

13. Which of the following payment methods do you accept in your practice? (Check all that apply) *This question is required.

Private/commercial insurance (includes all private insurance, managed & non-managed, excluding all categories below)
Medicare (including Medicare HMOs)
Medicaid (including Medicaid HMOs)
Other government/public (e.g., Dept of Veterans Affairs, Tricare, state/local funding)
No charge/uncompensated
Self-pay (e.g., patient does not have insurance, patient’s insurance does not cover your services, patient chose not to use insurance, etc)
Other (including worker’s compensation)
Don't Know

14. To assist our team, do you have any specific questions you need answered, or are you looking for general information? *This question is required.