NMR Clinical Trial Investigator Volunteer Request Form

A nutraceutical focused
contract research organization

Investigators

Calling all clinical trial investigators and clinical research centers: Nutraceutical Medical Research LLC is always looking to recruit talented and experienced investigators to oversee clinical trial studies on an on-going basis. Investigators interested in volunteering your site for a clinical trial, please complete the information-secured form below. Investigators will be contacted based on qualifications and need.

Title:

Last Name:	First name:

Medical Specialty (e.g.: cardiology, gastroenterology, oncology):

Name of Institution:

Type of Institution (Academic Medical, Community Hospital, Private Practice etc):

Street Address:	Suite/PO Box:

City:

State/Province:	Zip/Postal Code:

Telephone:	Country:

Fax:

Email:

Main Contact Person:	Email for Main Contact:

Site Coordinator/Study Coordinator:	Email for Main Coordinator:

Website:

IRB (Central or Local) (Please circle one and list other special IRB information for your institution):

Clinical Trial Experience: Please list disease/indication, brief description, phase of study, enrollment (actual/target)

See also

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