TrialMatch Listing Request Form

This form is intended for documentation of trial information and patient-/public-facing content for Alzheimer's Association TrialMatch. Complete all sections of this form and attach any required supporting documents. If you have any questions about the listing request process, please call 872.249.0282 ext. 2269 or email us at TrialMatch@alz.org.




This will be the header in search results


Provide the following information about the requestor. This information will not be visible to the patient/public and will only be used for following up on this request.












Provide the following general information about the request. This information will not be visible to the patient/public and will only be used for processing the request.












Provide the following general information about the study. This information will be visible to the patient/public and will also drive Search Engine Optimization.




Please include a protocol ID, as IRB number or grant number. Your protocol ID will serve as your unique identifier on TrialMatch.


























Choose the estimated recruitment start date. If recruitment has already started, leave blank.


Choose the estimated recruitment end date.


Provide information about the study site(s). This information will be visible to the patient/public and will also drive Search Engine Optimization.












Information for additional sites will be requested at time of listing approval.


Provide the following information about participant eligibility for the study. This information will be visible to the patient/public and will also drive Search Engine Optimization.


Input all appropriate conditions. If multiple, delimit with commas.












Provide additional information about the study. Some of this information may be visible to the patient/public and will also drive Search Engine Optimization.


How many visits/sessions? How long are the visits? Time between visits? Etc.


E.g. answering questions over the phone, receiving an infusion once a month, taking a medication by mouth daily, exercising twice weekly, using a device, etc.








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