American Psychiatric Publishing, Inc.
Publisher for the American Psychiatric Association
Is this a Rush Request?
(Standard processing time is 2-4 weeks. With rush service your request will be processed within 2 business days. A $50 rush processing fee will apply.)

PART I. Contact Information:

Name of Person Making the request: 
Name of Company or Organization:
Complete Postal Address:  
Country:  
Email Address for Contact Person:
Telephone Number for Contact Person: 
Facsimile Number for Contact Person: 
Are you the author of the material you are requesting?
Are you a member of the American Psychiatric Association?
 

PART II. Material to be Reproduced:

(Note: Sections of DSM-IV-TR that may NOT be reprinted include complete chapters or Appendices A, G, and H.)

Journals:
Journal Name: 
Issue Volume and Year:
Complete Article Title:
Author of Article:
Sections, Figures, Tables, or Images to be produced (List and Specify Page numbers): 
Are you requesting use of entire article:
Books:
Book Title: 
Author:
Year Published:
Sections, Figures, Tables, or Images to be produced (List and Specify Page numbers): 
For DSM IV TR Criteria Requests (List Criteria):
 

PART III. Description of Your Proposed Product:

Your Product Type:








Title of your proposed product:
Author (if applicable):
Publisher or Distribution Company Name:
Number of Copies to Print:
Unit Retail Price:
Is your product a printed publication or an electronic product or both?
In which countries are you planning to distribute your product?

Please provide a general description of your proposed Product:
You can attach a document to your request. If you need to attach sample pages or if you are requesting several items and need to attach a list, please do so here: Attachment:

Types of Rights You are Requesting:
For Electronic Products
How many users can be expected to access each product?
Will product be resold?
Will there be a one-time fee for unlimited use, a subscription based fee, a user-based fee, or an access-based fee for each use, or other type fee (specify)?
List fee amount:
Will the APA/APPI material be published on the Internet?
If so, will access be restricted (specify)?
 

PART IV. 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 owned by APA or APPI is unauthorized unless and until I am in receipt of a signed Permission letter or Electronic Product License Agreement.

I further acknowledge that my proposed use may be such that I may be required to enter into an Electronic Product License Agreement in APA or APPI's sole discretion.

I further acknowledge that if any usage or administrative fees are assessed by APA or APPI, the signed permission may be withheld until such fees are paid.


  Agree   Disagree    

 




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