Request edit access
INTUBE study - Call for center form
Please fill in this form completely and press the "send" button at the end of this page (one application for each institution).
Email address *
INternational observational study To Understand the impact and BEst practices of airway management of critically ill patients
Institution name *
Type of hospital
Clear selection
Department *
Address *
Post code *
City *
Country *
Number of ICUs of your institution
Total number of ICU beds
How many in-hospital endotracheal intubations of critically ill patients are performed in your institution in a week?
Clear selection
Principal investigator
Title
Clear selection
Last name *
First name *
Date of birth
MM
/
DD
/
YYYY
Office phone
Mobile phone
E-mail *
Second contact person
Title
Clear selection
Last name
First name
E-mail
I give my permission to publish my center name on the INTUBE study website (www.intubestudy.com) *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy