BECOME A CLINICAL INVESTIGATOR

For Sites

Register your site with CONFIDENCE to be considered for study opportunities

* By completing this form you agree that Confidence and Confidence’s representatives may contact you and/or your staff to discuss ongoing clinical trial opportunities. Confidence will not sell your contact information to any third party, but may provide it to (1) Clinical Trial Sponsors for further consideration your participation in clinical trials; (2) Confidence’s agents, contractors and business partners for the purpose of clinical trial conduct; (3) Confidence’s affiliates and subsidiaries; (4) Law enforcement agencies, regulatory agencies as necessary to comply with legal or regulatory obligations

1. Principal Investigator Name and Contact Information:

2. Site Name and Address:

3. Please provide Contact Person information for future contact:

Site Information

4. Please provide the type of your site:

5. Please provide the following information about the Principal Investigator:
Number of years in Clinical Research:

Therapeutic area:

Number of industry-sponsored clinical trials conducted in the last 5 years:

6. Please provide the following information about Study Coordinators at your site:
Total number of Coordinators at your site:

Number of Coordinators with 3+ years of experience in clinical research:

7. What patient age groups do you treat? (Mark all that apply)

8. What type of IRB / EC does your Site use?

Please enter the name of the preferred Central IRB / EC (if applicable):

9. How many weeks are typically required to receive IRB / EC approval?

10. Are there any other committees/approvals needed for your site?

If YES, please explain:

11. What is the typical time for your site to execute a Clinical Trial Agreement (CTA)? (weeks)

12. Are there any other committees/approvals needed for your site?