I-ACT for Children Site Network Questionnaire

Site Network Questionnaire

Site Network Questionnaire

Point of Contact

Physician Site Champion

Required Files

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Maximum upload size: 134.22MB
Drop a file here or click to upload Choose File
Maximum upload size: 134.22MB
Drop a file here or click to upload Choose File
Maximum upload size: 134.22MB

Section 1: General Information

Section 1

What percentage of each category makes up the population your institute provides care for:

Section 2: Satellite Site Information

Section 2

Section 3: Contract, Institutional Review Board, Other Review Information

Section 3

Sub-specialty 1

Sub-specialty 2

Sub-specialty 3

Sub-specialty 4

Sub-specialty 5

Section 5: Research Team Information

Section 5

FTEs

Section 6: Research Team Training

Section 7: Research Compliance Information

Section 8: Research Facility Information

Section 9: Investigational Drug / Product Information

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