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Ballpark request

For a ballpark for clinical conduct, please provide the following information:

Type of study(Required)

Number of study parts(Required)

Study population(Required)

Dose escalation required?(Required)

Yes

No

Number of cohorts(Required)

Subjects per cohort(Required)

Clinical entrances per cohort(Required)

Dosing days per cohort(Required)

Ambulant visits per cohort(Required)

FU visits per cohort(Required)

Additional services(Required)

Please indicate if additional services should be included in the ballpark:

Pharmacy

Regulatory

Clinical Monitoring

Data Management

Bioanalysis

Statistics

TMF

Pharmacovigilance

Project Management

Other

Other(Required)

Any additional information to take into consideration

Name(Required)

Email(Required)

Phone number

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