There are many ways that you can help contribute to an FDA-approved FMT product. You may serve as a clinical site, enrolling patients directly, or you may help refer patients that might qualify for the trial, so that together we can rapidly move towards a robust validated FMT treatment. Even simply completing this survey will help us understand practices in the field to design a clinical trial that matches clinical practice.

Please help us by completing the short survey regarding your interest in contributing to a clinical program to evaluate the safety and efficacy of FIN-403, an encapsulated microbiota preparation to prevent recurrence of recurrent Clostridium difficile infection. 

* 1. Please provide your facility's name:

* 2. Please provide a physician contact:

* 3. Please indicate the contact physician's speciality

* 4. What is the physician's preferred method of contact?

* 5. If the physician is not the primary point of contact, please provide an additional contact from your facility for us to reach out to with more information on the FIN-403 clinical program (eg. Clinical Research Coordinator).

* 6. Would you like more information about being a study site?

* 7. Would you like more information on being a referral site?

* 8. What could we do to help incentivize you to refer patients to a nearby clinical site, even if you aren’t able to serve as a site yourself?

* 9. In the last six months, how many patients has your facility treated with FMT?

* 10. What percentage of patients treated with FMT would prefer capsules over other methods (e.g. colonoscopy, enema, naso-enteric tube)?

0
i We adjusted the number you entered based on the slider’s scale.

* 11. What percentage of your patients treated with FMT would meet the following key eligibility criteria (having the inclusion criteria and not having any exclusion criteria)?

Inclusion:
Recurrent C. difficile - associated diarrhea (CDAD) defined as:
a) ≥ 3 episodes of C. difficile infection (CDI) with 2 within the previous 12 months, inclusive of current episode who have responded to standard of care  antibiotics; OR
b) 2 CDI episodes requiring hospitalization within the previous 12 months who have responded to standard of care antibiotics*.

Exclusion:
1. Inability (e.g. dysphagia) or unwilling to swallow capsules
2. Admitted to or expected to be admitted to an acute care facility or intensive care unit
3. Active inflammatory bowel disease

0
i We adjusted the number you entered based on the slider’s scale.

* 12. How does your facility diagnose Clostridium difficile infection?

  Never Sometimes Often Always
PCR/NAAT for C. difficile toxin gene
Toxin A/B EIA
GDH EIA then toxin A/B EIA
Other

* 13. Has your facility served as a study site in a clinical trial before?

* 14. Do you have any competing clinical trials in recurrent Clostridium difficile infection?



Thank you!

T