REACT - Site Evaluation Form

CONTACT INFORMATION

17% of survey complete.

Question Title

* 1. Principal Investigator

First Name *

Last Name *

Degree

Address *

City *

Province *

Postal Code

Email

Phone # *

Fax # *

Question Title

* 2. Principal Investigator preferred method of communication

Email

Phone

Question Title

* 3. Study Coordinator

First Name

Last Name

Degree

Address (if different from Principal Investigator)

City

Pronvince

Postal Code

Country

Email Address

Phone Number

Question Title

* 4. Study Coordinator preferred method of communication

Email

Phone

Question Title

* 5. Please provide the preferred contact number and time when the PI and SC can be reached:

PI - phone #

PI - time

SC - phone #

SC - time