Investigator | SIARAMRESEARCH

Name

Date of Birth

Medical Qualification

Medical Registration Number

Phone

Mobile

Website

Fax

Primary Hospital

Address

Contact Name

Phone

Fax

Mobile

Website

Comments

Any Other Hospital

Have you conducted Clinical Trials?*

Yes (If Yes, specify details below) No

Details of Clinical Trials conducted (Phase, Duration, Therapeutic area etc)

GCP Trained*

Yes No

Association with any Ethics Committee?*

Yes No

Approximate No. of patient pool in respective theraupetic area

Any other details if any