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Become A Studycast Affiliate Investigator

Studycast Research Centers assists private practice physicians in providing total health care options to their patients through clinical research.  We manage critical clinical activities including grant sourcing, contract and budget negotiation and management, facilitation of effective communication with sponsors, regulatory document preparation, CRF completion, and study monitor visit management.  Our processes ensure accurate and timely billing and collections.

If you would like to become a Studycast Affiliate Investigator, please complete the following form.

 
Name
Practice Name
Type of Practice
City
State/Province
Postal Code
Country
Phone
Fax
Email

 
Medical
License #s

 

 




State(s) of
Licensing

 

 





     
Medical Specialty
(Hold down Control key for multiple selections)

 

 

 

 

 



Research Interests
(Hold down Control key for multiple selections)

 

 

 

 

 


 
 		 
List Board Certified Specialties

Do you have clinical research experience?
If yes, number of years of experience?
Approximately how many studies?

Clinical Indications Study Dates #Patients

   
List all Pharmaceutical Sponsors for whom you have conducted studies within the last 18 months
(separate companies with a comma)

Does your staff have clinical research experience?
Have you ever received an FDA-483 or an FDA warning letter?

Are you currently a pharmaceutical company consultant?

Are you willing to make presentations about your research?

Can you use inpatients in clinical trials?
Can you use outpatients in clinical trials?

Can you use a central IRB?

Number of physicians in your practice
Would they potentially participate in research projects?
If yes, name

 
In what clinical indications do you have an interest in conducting research?

Does your practice have access to the internet?
If no, would you be interested in working with Studycast to incorporate it into your practice?

Do you perform your own billing?
Do you use a billing service?
Can you obtain a billing summary report by ICD9 codes?

Please list the top ten ICD9 codes from your practice and the approximate number of utilizations per month.
Indication/ICD9 Code #/Mo Indication/ICD9 Code #/Mo

What percentage of your practice is:

Inpatient :
Total number of active patients in your practice :

What percentage of your patients are:

Adults Adolescents Pediatrics
Males Females

Caucasian African American
Mexican American Asian

Comments

         
 

 

The Link Between Sponsors
and Pharmaeutical Investigators

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