Enrollment Form for Bicycle Health MindWell Participants
Overview:
You have been invited to participate in the MindWell program by your Bicycle Health provider. In order to enroll, you must be a patient at Bicycle Health who is prescribed buprenorphine (e.g., suboxone) for Opioid Use Disorder. Cambridge Health Alliance (CHA) provides electronic surveys to be completed by Bicycle Health patients. These surveys will help Bicycle Health to be able to provide mental health and services resources and recovery support to their patients when they need it.
If you choose to enroll, you will be asked to electronically complete several confidential computerized surveys after enrollment into the Bicycle Health MindWell Program. Scores from the questionnaires you complete will be generated and shared with your Bicycle Health prescriber to share with you.
After completing the questionnaires, you also may become eligible to participate in paid research studies. If you are willing to be contacted about potential research opportunities, please answer below.
After enrolling in the Bicycle Health MindWell Project, you will receive a link to complete three online questionnaires: the Brief Addiction Monitor (BAM), the Perceived Stress Scale (PSS) and CAT-MH, which will be conducted on the Adaptive Testing Technology (ATT) website.
ATT has a secure, confidential system for maintaining sensitive patient information and has an agreement with CHA to protect this information and only share it with CHA MindWell team and your Bicycle Health Provider. CHA has a process in place so that ATT will not receive any personal identifying information about you, this will ensure that ATT will NOT be able to link your responses to your personal identity. CHA uses confidential computer systems, including Health Cloud, to store your results and share them with Bicycle Health.
By clicking agree below, I am attesting that I understand I may be enrolled in the Bicycle Health MindWell Program where I will have the opportunity to complete three computerized questionnaires. I understand that Bicycle Health providers may use this information to help me find mental wellness or social support resources and recovery support that are a good fit for me. I am agreeing to complete these confidential computerized surveys on the CHA, Health Cloud, and ATT websites. I understand the CHA, Health Cloud, and ATT websites are designed to be secure and protect my confidential information, but that any online information may be susceptible to privacy breaches.
