Submit Clinical Trial Information

Please use this form to submit details of a trial for inclusion in our list.
* = Required field

* Full name:
* Position:
* Email address: (Confirmation email will be sent here)
* Phone number:
* Trial short name:
* Trial long/descriptive name:
* Brief description of trial:
* Eligibility criteria:
* Exclusion criteria:
* Intervention:
* Main outcomes:
* Secondary outcomes:
* Total number of patients required:
* Date recruitment started / planned:
* Date recruitment finished / planned:
* New centres needed:	Yes No
Number new patients required:
* Funding source:
* Contact name:
* Contact position:
* Contact address:
Contact phone:
Contact fax:
Contact email address:
Study web site:
Other info / comments: (will not be displayed on site)
Trial Login Details Please enter the email address you wish to use to allow you to update your trial in the future. Please enter again even if it is the same as any entered above. If you forget your password you will be able to retrieve this using the retrieve password/s function on the Trial login page.
* Email address:
* Choose password: (to allow you to update your entry)
* Confirm password:
Security Code:
Code:
* Enter Code:	(Please enter the above code)
To submit this information please click the 'Submit Trial' button once only even if nothing appears to happen for some seconds. Your submission will be added to the database and you will automatically be emailed with instructions on how to alter or update your entry in future. Please note that your submision will not be visible on the site until it has been approved by the BAPM administrator.