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Personal Details
Investigator Registration Form
All fields of asterisk mark (*) are mandatory.
*Full Name
*Gender
Male
Female
*DOB
*Qualification
*Name of Hospital/ Clinic/Organization
*Address
Affiliations
*Designation
*Mobile No.
Telephone No.
Fax No.
*Email for future communications
*Please enclose a copy of your current CV emphasizing experience in Research (Upload Word or PDF format file, not more than 5mb.)
Key Publications
*What is the most suitable time for our co-ordinators to connect to you over phone taking into consideration your OPD and clinic timings.
Site Details
Have you participated in any research in the past recent years?
Yes
No
If yes, please mention the area of interest ?
Patient Pool Details
Astma
0
10
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80
90
100
120
130
140
150
160
170
180
190
200
More than 200
COPD
0
10
20
30
40
50
60
70
80
90
100
120
130
140
150
160
170
180
190
200
More than 200
Other 1
Other 2
Do you have access to the following?
Forced Oscillometer (FOT)
Yes
NO
If yes, please specify the company/ provider name of the device
Impulse Oscillometer (IOS) (FOT)
Yes
NO
If yes, please specify the company/ provider name of the device
Spirometer
Yes
NO
If yes, please specify the company/ provider name of the device
Model
Calibration check frequency
Peak Flow Meter
Yes
NO
DLCO
Yes
No
Body Plethysmograph
Yes
NO
Skin Prick Test
Yes
No
Do you have access to Institutional Ethics Committee (IEC)?
Yes
NO
If yes, name of the IEC?
What is the time frame required to submit proposals of academic studies to the IEC at your institute?”
What are the preferred languages in which you will need the Informed Consent Form (ICF) & Patient Information Sheet (PIS)?
