Site Database
Hello,

Welcome to the Biorasi Global Site Database Registration form. Here you can register or update your site to be included in our Global TALOS™ Site Database; we want to thank you for your interest in taking part in our studies. If you have previously registered please resubmit your site to our new updated platform herein.

In an effort to keep our database current, we kindly ask that you update the below information for your site. It is important that all fields are filled out correctly in order for the information to be populated into our updated site database.

If you have any questions regarding your submission, please do not hesitate to reach out to our Director of Program Management, Ignacio Handal Ihandal@biorasi.com.

Thank you for your time and we look forward to the opportunity to work with you in the near future.

Warm Regards,

The Biorasi Family

Email address *
Site Information
Site Name *
Your answer
Street Address *
Your answer
City *
Your answer
State
Zip Code *
Your answer
Country *
Phone Number *
Your answer
Fax Number *
Your answer
Site Webpage *
Your answer
Phase Focus *
Required
Key Therapeutic Area(s)- Please only select up to five (5) *
Required
Principal Investigator (PI) #1 Information
Enter up to three (3) PI's from your site, with a minimum of one (1) PI required.
PI First Name *
Your answer
PI Last Name *
Your answer
PI Direct Phone Number
Your answer
PI Email Address *
Your answer
Board Certification
Subspecialty(ies)
Principal Investigator (PI) #2 Information
PI First Name
Your answer
PI Last Name
Your answer
PI Direct Phone Number
Your answer
PI Email Address
Your answer
Board Certification
Subspecialty(ies)
Principal Investigator (PI) #3 Information
PI First Name
Your answer
PI Last Name
Your answer
PI Direct Phone Number
Your answer
PI Email Address
Your answer
Board Certification
Subspecialty(ies)
Is your site affiliated with an SMO? *
If yes, what SMO?
Your answer
What IRB type may your site may use. *
Required
If you must use a specific IRB, please specify which.
Your answer
What is the approval time (in weeks) for the IRB above?
Your answer
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