Submission Type – New Registrations and Updates will be posted within one working week.

Submission Type (required)

New RegistrationUpdate Previous Registration

Investigator Information

Investigator’s First Name (required)

Investigator’s Last Name (required)

NOTE: Check email. Must be correct. All communications such as trial proposals will be sent to this email.

Investigator's Email (required)

Investigator’s Prefix (required)
Dr.

Investigator’s Academic Degrees - Multiple Selections Possible (required)
MDPhDMBADDSPharmDMasterBachelor

Investigator’s Medical Speciality - Select One (required)
AllergyAnasthesiologyCardiologyCritical CareDentalDermatologyEar Nose ThroatEmergency MedicineEndocrinologyFamily MedicineGastroenterologyGeneral MedicineGeneticsGeriatricsGynecologyHematologyHepatologyImmunologyInfectious DiseasesInternal MedicineLaboratory MedicineNeurologyObstetricsOncologyOphthalmologyOrthopedicsPediatricsPharmacologyPsychiatric DisordersPulmonaryRadiologyRehabilitationRheumatologySport MedicineSurgeryUrology

Investigator's Bio - Truncated at 150 words (put NA if no BIO)

Investigator’s Bio (required)

Number of Trials Conducted by Investigator Annually - Average (required)
Trials per year: 0Trials per year: 1-2Trials per year: 3-4Trials per year: 5-6Trials per year: 7-8Trials per year: 9-10Trials per year: >10

Investigator’s Trial Interest – List maximum seven (7) conditions / diseases (separator, comma sign)

Condition / Disease (required)

Preferred Study Type(s) - Multiple Selections Possible (required)
Industry-SponsoredNIH etcInvestigator-Initiated

Preferred Study Phase(s) - Multiple Selections Possible (required)
Phase I.Phase II.Phase III.Phase IV.Observational Studies

Preferred Study Product(s) - Multiple Selections Possible (required)
DrugsVaccinesMedical DevicesCell TherapiesNatural ProductsMedical DiagnosticsRadiology / ImagingMedical ProceduresSurgery

Study Site / Medical Clinic Information

Site Name (required)

Site Location - Address (required)

Site Location - City (required)

Site Location - State US First (required)
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington DCWest VirginiaWisconsinWyoming

Site Location - Zip (required)

Site Location - Country (required)
USACanadaOther

The phone number will be listed on the Clinical Investigator Gazetteer website. You can avoid this by not giving the phone number below - give NA.

Site Contact – Phone (required)

The site's website will be listed on the Clinical Investigator Gazetteer website. You can avoid this by not giving the website below - give NA.

Site Website (required)

NOTE: Check email. Must be correct. Some general information will be sent to this email.

Site Email - Contact (required)

Study Site Description - Truncated at 150 words (put NA if no description)

Site Study Services (required))

Study Site / Medical Clinic Characteristics

Clinic Type (required)
AcademicNIHPublic HospitalPrivate HospitalPublic ClinicPrivate ClinicDedicated Research ClinicOther

Site Type (required)
Trial Organization/AcademicTrial NetworkStand AloneOther

IRB Type (required)
Institutional IRBGovernmental IRBCentral IRB

Declaration by Investigator

I understand the terms of this submission and accept the terms (required)
YesNo