Study Request Form

Form to request the creation of a new study on the Quintiles environment

GENERAL INFORMATION

Required

Study name

Study description/synopsis

Study phase

Regulatory

Yes

Therapeutic area

Indication

STUDY DETAILS

Total number of sites

Total number of patients

Estimated Go-Live Date

Estimated FPI Date

Program name

Study duration (in month)

Total number of countries

Total number of eCRF pages

Primary country

Number of treatment arms

Number of unique eCRF pages

Number of external data sources

TECHNICAL DETAILS

EDC Platform

IVRS Integration

Yes

Coding using TMS

Yes

JReview

Yes

REQUEST DETAILS

Requester first name

Requester last name

Requester mail

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