ClinicalTrials.gov Consultation Intake Form

ClinicalTrials.gov Consultation Intake Form

Please complete this form to help us better assist you with your request. Once completed, the ClinicalTrials.gov Team will follow up with you.

Person Requesting (First & Last Name)*

Email Address*

Phone Number*

Phone

Department*

Select or enter value

Reason for Consultation*

Please provide a brief description of your needs (initial registration, results submission, new CT.gov account request, etc.)

Study Title (Short Name)*

IRB of Record*

Are you using UCD IRB or relying on another IRB of record for this study? Please specify.

Select

IRB Number*

Please enter the IRB# or provide us with the IRB status (pending submission, submitted pending review, etc.)

NCT Number (ClinicalTrials.gov)*

Enter N/A if not applicable

Document Upload*

Please attach your current Protocol, Informed Consent Form(s) or any other study materials you would like to share. You may attach multiple documents here.

Drag and drop files here or

Send me a copy of my responses

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