Clinical Data Management Support

1. Contact details

   Name *

   Department/Affiliation *

   Email *

   E.g. firstname.lastname@company.com

   Contact Number

   Please include your phone number if you prefer to be contacted by phone.

   Project Title *

   SFU Research Portal Project Number Available? *

    Yes

    No

   SFU Research Portal Project Number *

   Is your study a Cinical Trial? *

   -----YesNo

   Registration Number

   Registration number at clinicaltrials.org or similar (WHO ICTRP, EU PAS Register):

   EMA-Registration Number *

   EMA (European Medicines Agency)

   Availability of grant money for data management: *

   -----YesNo

2. Project Description

   Information

   Please complete this form as thoroughly and accurately as possible to expedite the review process and minimize the need for follow-up questions. This will help us schedule a more efficient and productive initial consultation.

   1. Please provide a detailed overview of your project *

   Including its data management plan, data vaildation, data collection methods, and expected supports (max. 1000 characters)

   <p class="western" lang="de-DE" style="line-height: 115%; margin-bottom: 0cm;">Click or tap here to enter text.</p>

   2. Initial Consultation *

   Please select all services you need (multiple choices allowed)

    Data management plan

    Data validation plan

    eCRF designing

    EDC Software comparison

    Don't need consultation

   3. Data Management Support *

   3.1.  Do you need Electronic Data Capture (EDC) software support from SFU?

    Yes

    No

    Don't need EDC software for now

   3.2. What specific support do you need? *

    Full Data Management (Include Conducting)

    Software Provision (Only) + Training

   3.2. Please describe what specific support you need? *

   Please provide all relevant information the data manager needs to support your study effectively — for example, the current study status, which EDC system you're using, and any specific requirements.

   <p>Click or tap here to enter text.</p>

   3.2.1. Please provide the following information for each person who requires EDC software training. *

   E.g. 1. Name, Position, Email address (preferred company email)

   <p>Click or tap here to enter text.</p>

   4. Indicate your desired timeline for the completion of the data management

   5. Are there any other relevant specific requirements or constraints?

   Is there anything else that should be taken into account that you would like to share?

   <p>Click or tap here to enter text.</p>

3. Summary

   Thank you for submitting your request for Clinical Data Manager (CDM) support!

   We will review your request, and a Clinical Data Manager (CDM) will contact you within 10 business days of receiving the form to discuss your project in more detail.

   We look forward to working with you!

4. Bist Du ein Roboter?
   Bist Du ein Roboter?