Dear Customer,

thank you for your study request, to generate an offer for you, please check where applicable. If you have additional requirements, please use the additional spaces provided. We are happy to support you if you have any questions.


Please note: Your information should be as final as possible. Subsequent changes may cause delays in the processing of your requests of up to 10 working days. We recommend filling out this form together with your regulatory department.

To check if this questionnaire can be used from your location, please first try: https://app.smartsheet.com/b/form/f49072da94214b8b9d26f03903687463

Please enter the company name.

Please indicate which analyte should be tested.

multiple selection possible

Auswählen
Caret IconCaret symbol
Auswählen
Caret IconCaret symbol

Please mark which device should be tested.

Auswählen
Caret IconCaret symbol

Please mark which device is to be used for reference testing.

Auswählen
Caret IconCaret symbol

Please mark the regulatory requirement according to which the performance evaluation is to be carried out.

multiple selection possible.

Wert auswählen oder eingeben
Caret IconCaret symbol

Please briefly state the objective of the study to be conducted.

Please indicate the number of subjects to be included in the study and the criteria to be considered. If not applicable, please enter "not applicable".

If not applicable, please enter "not applicable".

If not applicable, please enter "not applicable".

Please indicate by when you expect an offer from Biomex

Please provide information on how quickly the equipment to be tested can be delivered to BIOMEX. For this purpose you can enter a date or a period of time (e.g. 2 weeks after signing the contract).

Please indicate by when the study should be completed, for this you can enter a date or a time period (e.g. two months after arrival of the test kits at BIOMEX).

Please indicate, if applicable.

Please indicate, if applicable.

Please upload the IFU (PDF or Word document) of the assay to be evaluated if already available, you are also welcome to upload other documents relevant for the processing.

The IFU helps us to process your inquiry more quickly and is required at the latest for the preparation of the study plan.

Ziehen Sie Dateien und legen Sie sie hier ab oder

Please indicate the name of the main contact person for the inquiry

Please indicate the E-Mail adress of the main contact person

The questionnaire includes 19 questions. If you would like to receive a copy of your entries by email, select the "Eine Kopie meiner Antworten an mich senden" (send me a copy of my entries) box below and enter your email address.

Datenschutzhinweis|Missbrauch melden
Diese Website ist durch reCAPTCHA geschützt und es gelten die Datenschutzrichtlinien und Nutzungsbedingungen von Google.