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Request for OCTR Services

To request services at this time, please check all items of interest and complete the information below. (A budget for OCTR services will be prepared for your review)

Contact Information

*Name:

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*Email:

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*Phone:

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Department:

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Name of PI:

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Study Sponsor:

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Name of Study:

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Protocol No.:

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Protocol Status:

Draft
Final

Study Start Date:

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Study Participants:

Inpatient
Outpatient

Target # of patients required:

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Pre-Study Services

IRB submission & follow up
Study budget preparation/negotiation (Based on final protocol)
Cancer Center Protocol Review & Monitoring Committee (PRC) submission & follow up (as appropriate)
Assistance with pre-study site visit
Study initiation
Attendance at Investigator's Meeting
Assistance with pre-study site visit
Study initiation
Attendance at Investigator's Meeting

Investigator's Meeting Date:

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Coordinator Services

Subject Screening
Subject Enrollment
Patient Scheduling
Study Drug Administration
Coordination of Protocol Procedures
Patient Monitoring/Adverse Event Reporting
Completion of Case Report Forms
Coordination of Monitor Visits
Arrange Long-Term Record Storage
Specimen Packaging and Shipping

Other

Use of Clinical Research Space
Study Development Servies (patient registries, electronic case report forms, etc.)

Please Specify Study Development Services:

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Any Services Not Listed Above:

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I would like more information on OCTR Services
I would like general information about conducting sponsored clinical trials

*Required Field

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