Medismart

Investigator Registration Form

Name and Surname
Title
Other
Name of Institution/Company
Division/Department
Phone
Mobile Phone
E-Mail
Clinical Research Experience
Pharmaceutical Drug/Compound
Vaccine
Gene-based Therapies
Radiologic
Medical Device
Pharmacokinetics
Diagnostic
Genetics
Current Research Practice Setting
What age group do you treat?
Neonatology
Paediatric
Adolescent
Adult
Geriatric
Ethics Committee/Institutional Review Board:
Research Phase Experience
(Check all that apply)
Phase I
Phase II
Phase III
Phase IV
Post Marketing Observational Study
Site Capabilities
(Check all that apply)
-70° Freezer
-20° Freezer
Centrifuge
On-site Lab
On-site Pharmacy
Home Health
Ultrasound
X-Ray
ECG
Dexa Scanner
CT Scanner
Please indicate if you have been audited by any of the following
(Check all that apply)
FDA
Other Sponsors
Other CROs
Do you have a computerized patient database?
Yes
No
Therapeutic area experience (Please indicate your primary therapeutic area experience)
Do you have Internet access at work?
Yes
No
Do you have experience in conducting studies using Electronic Data Capture (EDC)?
Yes
No
Would you be interested in participating in studies using EDC?
Yes
No
Verification Code
mediSMART Medical Research LTD Ekinciler Caddesi Elbistan Sokak Pekiz Plaza No: 5 Kat:B2 34810 KAVACIK BEYKOZ İSTANBUL TURKEY
Tel: +90 (216) 404 10 88 Fax: +90 (216) 404 10 87 , info@medismart.com.tr
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