Crossover | Registration | Healthcare institution/investigator registration

News

Crossover has developed a
clinical trials database
for its partner hospitals
and investigators ... more

Nathalie Vandenhoudt, PhD,
Clinical Study Coordinator
at the Crossover Clinical
Research Unit in Brussels ... more

Crossover observes a
continuing decline in
industry-sponsored clinical
trials. Since ... more

Events

Lecture at the University
of Neufchâtel,
Switzerland
Jean-Pierre Tassignon, MD, ... more

Public lecture at CHU
Brugmann, Brussels
Prof. Anne Peretz (chair of
the Clinical Research ... more

EFGCP Annual Conference
2011, Budapest
The European Forum for GCP
organizes the EFGCP Annual ... more

*	Title:
*	First name:
	Middle Initial(s):
*	Last name:
	Educational qualifications:
*	Healthcare institution/Organisation:
*	Job title:
*	Department:
	Address1:
	Address2:
	Address3:
*	City:
	Zip/Postcode:
	Country:
*	Telephone:
	Fax:
*	E-mail address:

Contact Information
Same as the Personal Information
*	First name:
*	Last name:
*	Job title:
*	Department:
*	Telephone:
	Fax:
*	E-mail address:


* You would like Crossover to:

List your institution in its Site Database
List you as a potential investigator in its Investigator Database
Contact your institution to discuss membership of COCRIN
	Other, please specify (e.g., your Institution has a CRU but would like to discuss a transfer to Crossover)


Previous Clinical Research Experience (if not applicable, please leave blank):

Pharmaceutical Drug/Compound	Vaccine
Gene-based Therapies	Cell therapy
Radiology/contrast media	Medical Device
Pharmacokinetics	Diagnostics
Genetics	Nutriceuticals

Current Research/Practice Setting (if not applicable, please leave blank):

Phase I Unit	Hospital Outpatient Care
Nursing Home	General Practice
Private Hospital (bed capacity)	Public Hospital (bed capacity)
Research Center	University Hospital (bed capacity)
VA/Military Hospital/Clinic(bed capacity)	SMO - please state name and website address:

What age group do you treat? (if not applicable, please leave blank)

Neonatology	Paediatric
Adolescent	Adult
Geriatric

Ethics Committee/Institutional Review Board:

Please indicate whether you work with an IEC/IRB? (if not applicable, please leave blank)
Central	Local

Research Phase Experience (if not applicable, please leave blank):

Phase I	Phase II
Phase III	Phase IV

Site Capabilities (if not applicable, please leave blank):

-70° Freezer	-20° Freezer
Centrifuge	On-site Lab
On-site Pharmacy	Home Health
Ultrasound	X-Ray
ECG	DEXA Scanner
CT Scanner	Radioisotopes
Magnetic Resonance Imaging equipment	Sleep lab
Emergency department	Intensive Care Unit
Maternity	Rehabilitation for cardiac patients
Cardiac catheterisation	Heart transplantation surgery
Respiratory physiology equipment	Radiotherapy department

Do you have a computerised patient database (electronic health record system)? (if not applicable, please leave blank)

YesNo

Therapeutic Area (if not applicable, please leave blank):
Please indicate your primary area of specialty/sub-specialty



Do you have experience in conducting studies using Electronic Data Capture (EDC)? (if not applicable, please leave blank)

YesNo

Would you be interested in participating in studies using EDC? (if not applicable, please leave blank)

YesNo

*Please enter your query or comments below: