Clinical Trial Directory Form

Clinical Trial Directory Form

List your clinical trial on the BaystateHealth.org website. Only actively recruiting trials should be listed.
Health Condition(s) or Problem(s) Studied (select most appropriate)*

Critical CareEmergency MedicineEndocrinology (Diabetes, Thyroid Disease)GastroenterologyHeart/VascularHematology (Blood)HIV/AIDSInfectious DiseaseInternal MedicineCancerNeurosurgeryNeurologyOb/GynObesityPathologyPediatricsPsychiatric (Behavioral Health)Pulmonary (Lungs)Rheumatology (Joints, Muscles, Bones)StrokeSurgeryVaccinesHealthcare Delivery & Population SciencesOther
If 'Other', please explain and note the specialty
Study Title Headline (please write for Layperson)*
Study Title (scientific)*
PI / Lead Researcher*

First NameLast Name
Phase*

Phase IPhase IIPhase IIIPhase IV
IRB#*
NCT#
Location (BMC, Baystate Children's, Baystate Wing, etc.)*
Primary Sponsor*
Purpose of the Study *
Please describe in 1-3 sentences using 8th grade reading level.
Eligibility*
2-3 high level inclusion/exclusion criteria
Recruitment Status*

ActiveComing SoonRecruiting
Active Date Opened to Enrollment/Recruitment*

MonthDayYear
Date
Trial Start Date*

MonthDayYear
Date
Trial Expire Date*

MonthDayYear
Date
Time commitment*
Contact Information

for subjects to contact to enroll in study
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Sign to confirm all of the information above*

Clear
If commercially sponsored, sign that you have received approval for posting this information on BaystateHealth.org by the study sponsor.

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Should be Empty:

Clinical Trial Directory Form

Contact Information