1. Informed Consent

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My name is Michael W. Bowdren, M.S. I am a graduate student at the California School of Professional Psychology at Alliant International University, Los Angeles. Volunteers are requested to complete a survey for a research study as a part of my dissertation project. The purpose of the study is to examine the attitudes of patients and health care providers toward mental health services in primary care settings.

Participation in this study is designed to take approximately 20 minutes. If you agree to participate in this study, you will first be asked to indicate whether you are a physician, a psychologist, or a patient (someone who has seen a medical doctor within the past year). You will then be directed to a survey designed specifically for physicians, psychologists, or patients, depending on your response to the first question. The survey will consist of questions about your thoughts and opinions about mental health services, as well as your own practices in providing mental health services, if applicable. You will then be asked some questions about how you would describe yourself. After completing the survey, you will have the option of submitting your email address to be entered into a raffle for one of two $100 gift cards. You may also request a summary of the overall results of the study once the study has been completed if you wish.

You may refuse to participate or withdraw from this study at any time before the completion of this survey. Should you choose to withdraw, there will be no penalty or loss of services as a result. Your identity as a participant in this study will be kept in strict confidence, and no information that identifies you in any way will be released without your separate written approval. All information that identifies you will be protected to the limits allowed by the law. The information that you provide in this survey will be linked to a Participation Identification Code that is assigned to you so that your name or other identifying information is not linked to your survey responses, and your survey information will be stored in a file separately from your signed consent form in order to further protect your confidentiality. All individual data collected for the purposes of this study will be destroyed by Michael W. Bowdren, M.S. within five (5) years of the date of the signing of the consent form.