247 CLINIC

Contact Form

Please complete the form below to briefly tell us about the work you would like to complete. We will use this information to inform our report for your proposal.

New Clinical Research or Study

Form completed by:

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1: What type of organisation are you ?

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2: Is this a new Project or Study?

Yes, this is a new Project .

Ready to develop

No, this is a mature project

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Program / Study details

3: Your Name?

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4: Your Email?

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Do you have a website or url we can visit?

Study Scope

5: What pathology would you like to investigate (e.g. COVID19, stroke, depression, anxiety, cognitive or digestive degeneration etc)?

Please select a valid condition(s).

6: How many participants do you expect to recruit over the life of your project?

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7: What type of study population would you like to recruit (e.g., age, gender, medicated, unmedicated, by location, by health status, domestic or international)?

Please enter valid participant(s).

8: Application Requirements?

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9: Data Requirements?

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