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Request for research study listing
Request for research study listing
Request for research study listing
Please complete details on this form if you would like your study to be posted on this website. If you would like prospective participants to know more about your study, please attach a Patient Information Sheet +/- consent form.
Project title
*
Please provide the project title.
Name of the Primary Investigator
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Institutional affiliation and position
*
Please identify the Primary Investigator's institution and position as relevant to the research.
Institution address
*
Please provide a the address of the Primary Investigator's institution (where the research will be undertaken).
Purpose of the study
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Please provide a short description of the research project in non-technical language (max 500 characters).
Study participants
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Please describe the desired study participants (inclusion/exclusion criteria). Please state if participation is limited to a hospital/health service; city; or country.
Name of IRB/ethics committee that has approved the study.
*
Name of the contact person for the study
*
Phone contact number
If there is a phone contact number for the study please include it here.
Email address
*
Please provide a contact email address for potential study participants
