HMRC Intake Form

Principal Investigator
Study Nurse/Study Coordinator
Does the study require injections
ECGs
Does the study require use of our machines and/or require interpretation?
Will the study require use of FMC CTU overnight beds?
Does the study require use of HMRC lab services?
Please select all services that are required
Please specify in the text box how long you require storage for (click the 'other' option to type).
Does the study require use of HMRC nursing services?
Please select all services that are required
Does this study require any after hours services?
Please specify 'Yes' or 'No' if this study requires parking for its participants.
One file only.
10 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, mp3.

Collection of personal information
Your personal information is collected under the authority of section 33(c) of the Freedom of Information and Protection of Privacy Act. If you have any questions about the collection or use of this information, please visit our Access to Information page.