Investigators

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This profile is being completed by:*
FirstLast
What is your primary role at this site?
Principal Investigator
Sub-Investigator
Study Nurse
Study Coordinator
Investigator Name:
FirstLast
Degree(s):
DO
MD
RPH
MS
MPH
PHD
MSN
MBA
Title:
Address/contact details where you wish to be contacted with potential studies:
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Phone Number
Email
Please check all the following Therapeutic Areas for which you have current experiences and/or interest in conducting studies:
Allergy & Immunology
Anesthesia
Cardiology
Dentistry
Dermatology
Emergency Medicine
Endocrine/Metabolism
Epidemiology
Gastroenterology
Genitourinary
Genetics
Gerontology
Hematology
Infectious Diseases
Intensive Care
Internal Medicine
Medical Devices
Nephrology
Neurology
Obstetrics/GYN
Oncology
Ophthalmology
Orthopedics
Otolaryngology
Pediatrics
Psychiatry
Pulmonology
Radiology
Rheumatology
Surgery
Transplant
Vascular Disease
What age group(s) does your site see? (select all that apply):
Pediatric
Adult
Geriatric
How long have you been conducting clinical trials?
What is the total number of trials that you have conducted as a Principal Investigator?
What is the total number of trials by phase that you have conducted as a Principal Investigator?
Phase I
Phase II
Phase III
Phase IV
How much time do you devote each week to clinical research as a Principal Investigator?
Does your site have experience with Electronic Data Capture (EDC) studies?
Yes
No
Is the Investigator fluent in English?
Yes
No
Does your site conduct research through a Site Management Organization (SMO) or network?
Yes
No
What type of hospital are you affliated with?
Community Medical Center
Dedicated Research Center
General Hospital
Private Hospital
Public Health/Military/Veteran's Hospital
Rehabilitation Center
University Hospital/Medical Center
What type of IRB/EC is your site able to use?
Local
Central (independent from your site, example WIRB)
Both Central and Local
What is your Practice/Research Organization Name:
What type of Practice/Research Organization is it? (Check all that apply):
Clinic
Clinical Trial Management Organization
Group Practice
Multi-Specialty
Primary Care Center
Private Practice
Research Center
Research Organization
Number of physicians in the Practice:
Number of investigators in the Practice:
What types of trials are you interested in conducting? (check all that apply):
Outpatient Trials
Inpatient Trials
Please feel free to provide any further information about your site, its experiences and/or interests in the space below:
Thank you for completing your profile with Aptiv Solutions. We will contact you when we have upcoming trials that match your experiences and interests based on this profile.