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Company Name:
Contact Person:
Title:
Email:
Phone Number:
Location (City/Country):
Therapeutic Area:
Study Phase:
Study Title:
Brief Study Summary:
Approximate Study Start Date:
Approximate Study Closeout Date:
1. Study Start-up*
2. Study Maintenance*
3. Study Closeout*
4. Full Support
Number of Countries:
Number of Sites:
Estimated Randomizations:
Duration of Study:
CRO Outsourced Study:
Number of Vendors:
Protocol Finalization:
First Site Activated:
First Patient Screened:
First Patient Randomized:
Last Patient Screened:
Last Patient Randomized:
Last Patient Last Treatment:
Database Lock for Primary Endpoint:
Additional Comments or Unique Needs:
Intended Date of Engagement / Hire:
Contract Term:
Scope: