Research Research projects Australian Interventional Pharmacotherapy and Psychedelic Assisted Psychotherapy Research Registry (AIPPAP-RR) Register your patient Australian Interventional Pharmacotherapy and Psychedelic Assisted Psychotherapy Research Registry (AIPPAP-RR) « About the Project About the Registry For Participants For Referrers Register your patient Privacy, Data Storage, and Data Access Psilocybin/MDMA Authorised Prescriber Human Research Ethics Committee Applications If you are a clinician and would like to refer a participant, please provide the details below and your patient will be invited to join the Registry. Patient details Patient’s full name Patient’s email address Patient’s age Referring doctor Referring doctor's full name Referring doctor's email address Has your patient consented to being contacted by us to be included in the Registry? Yes No Please nominate a Clinician who will be responsible for completing clinician questionnaires. Clinician email Treatment Medication to be used Medication to be used - Select - Psilocybin MDMA Ketamine Other… Enter other… Indication for treatment Intended treatment date Additional Information Has the participant previously received MDMA/psilocybin treatment using the Registry for outcome monitoring? Yes No Previous registry number Is this participant eligible for the SOOTHE study? Yes No Medibank ID Number Is the patient funded through DVA? Yes No If this patient has already commenced/completed treatment and you would like to contribute your clinically collected data to the registry, select Yes to the following question and further instructions will be provided. Would you like to contribute previously collected clinical data? Yes No CAPTCHA
