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The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

/^((0?[1-9])|([1-8][0-9])|(9[0-8]))[0-9]{3}$/

/^((29([-\/])02\3(\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00)))|((((0[1-9]|1\d|2[0-8])([-\/])(0[1-9]|1[012]))|((29|30)([-\/])(0[13-9]|1[012]))|(31([-\/])(0[13578]|1[02])))(\11|\15|\18)\d{4}))$/

/^((02([-\/])29\3(\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00)))|((((0[1-9]|1[012])([-\/])(0[1-9]|1\d|2[0-8]))|((0[13-9]|1[012])([-\/])(29|30))|((0[13578]|1[02])([-\/])31))(\11|\15|\19)\d{4}))$/

/^(((\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00))([-\/])02(\6)29)|(\d{4}([-\/])((0[1-9]|1[012])(\9)(0[1-9]|1\d|2[0-8])|((0[13-9]|1[012])(\9)(29|30))|((0[13578]|1[02])(\9)31))))$/

/^(((\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00))([-\/])02(\6)29)|(\d{4}([-\/])((0[1-9]|1[012])(\9)(0[1-9]|1\d|2[0-8])|((0[13-9]|1[012])(\9)(29|30))|((0[13578]|1[02])(\9)31)))) (\d|[0-1]\d|[2][0-3]):[0-5]\d$/

/^Pro\d{8}$/

/^(?!\.)((?!.*\.{2})[a-zA-Z0-9\u0080-\u02AF\u0300-\u07FF\u0900-\u18AF\u1900-\u1A1F\u1B00-\u1B7F\u1D00-\u1FFF\u20D0-\u214F\u2C00-\u2DDF\u2F00-\u2FDF\u2FF0-\u2FFF\u3040-\u319F\u31C0-\uA4CF\uA700-\uA71F\uA800-\uA82F\uA840-\uA87F\uAC00-\uD7AF\uF900-\uFAFF!#$%&'*+\-/=?^_`{|}~\d]+)(\.[a-zA-Z0-9\u0080-\u02AF\u0300-\u07FF\u0900-\u18AF\u1900-\u1A1F\u1B00-\u1B7F\u1D00-\u1FFF\u20D0-\u214F\u2C00-\u2DDF\u2F00-\u2FDF\u2FF0-\u2FFF\u3040-\u319F\u31C0-\uA4CF\uA700-\uA71F\uA800-\uA82F\uA840-\uA87F\uAC00-\uD7AF\uF900-\uFAFF!#$%&'*+\-/=?^_`{|}~\d]+)*@(?!\.)([a-zA-Z0-9\u0080-\u02AF\u0300-\u07FF\u0900-\u18AF\u1900-\u1A1F\u1B00-\u1B7F\u1D00-\u1FFF\u20D0-\u214F\u2C00-\u2DDF\u2F00-\u2FDF\u2FF0-\u2FFF\u3040-\u319F\u31C0-\uA4CF\uA700-\uA71F\uA800-\uA82F\uA840-\uA87F\uAC00-\uD7AF\uF900-\uFAFF\-\.\d]+)((\.([a-zA-Z\u0080-\u02AF\u0300-\u07FF\u0900-\u18AF\u1900-\u1A1F\u1B00-\u1B7F\u1D00-\u1FFF\u20D0-\u214F\u2C00-\u2DDF\u2F00-\u2FDF\u2FF0-\u2FFF\u3040-\u319F\u31C0-\uA4CF\uA700-\uA71F\uA800-\uA82F\uA840-\uA87F\uAC00-\uD7AF\uF900-\uFAFF]){2,63})+)$/i

/^[1-3]{5}$/

/^[\s\S]{0,50}$/

/^\d{2}.\d$/

/^[-+]?\b\d+\b$/

/^[a-z]+$/i

/^\d{10}$/

/^[a-z0-9-_]+$/i

/^[-+]?[0-9]*\.?[0-9]+([eE][-+]?[0-9]+)?$/

/^-?\d+,\d$/

/^-?\d+\.\d$/

/^-?\d+,\d{2}$/

/^-?\d+\.\d{2}$/

/^-?\d+,\d{3}$/

/^-?\d+\.\d{3}$/

/^-?\d+,\d{4}$/

/^-?\d+\.\d{4}$/

/^[-+]?[0-9]*,?[0-9]+([eE][-+]?[0-9]+)?$/

/^($0[2-8]$|0[2-8])\s*\d{4}\s*\d{4}$/

/^(?:$?([2-9]0[1-9]|[2-9]1[02-9]|[2-9][2-9][0-9]|800|811)$?)\s*(?:[.-]\s*)?([0-9]{3})\s*(?:[.-]\s*)?([0-9]{4})(?:\s*(?:#|x\.?|ext\.?|extension)\s*(\d+))?$/

/^((((\+44|0044)\s?\d{4}|$?0\d{4}$?)\s?\d{3}\s?\d{3})|(((\+44|0044)\s?\d{3}|$?0\d{3}$?)\s?\d{3}\s?\d{4})|(((\+44|0044)\s?\d{2}|$?0\d{2}$?)\s?\d{4}\s?\d{4}))(\s?\#(\d{4}|\d{3}))?$/

/^\d{4}$/

/^[ABCEGHJKLMNPRSTVXY]{1}\d{1}[A-Z]{1}\s*\d{1}[A-Z]{1}\d{1}$/i

/^(0[1-9]|[1-9]\d)\d{3}$/

/^[A-Z]{2}\d{4,}$/

/^\d{3}-\d\d-\d{4}$/

/^(\d|[01]\d|(2[0-3]))(:[0-5]\d){2}$/

/^([0-9]|[0-1][0-9]|[2][0-3]):([0-5][0-9])$/

/^[0-5]\d:[0-5]\d$/

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/^\d{5}(-\d{4})?$/

XfWEHEuU8CWsgTV6W5eII35P6vwN2VrYAjIdw7hrDpAwxvUd2

DOCR Services Request

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First Name

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Last Name

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Phone Number

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CRU

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Specify Other

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Are you the PI?

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Yes No

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First Name

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Last Name

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RPM First Name

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RPM Last Name

* must provide value

RPM Email

* must provide value

First Name

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Last Name

* must provide value

You may download a Facilities and Resources here.

Do you have a written protocol for the study?

* must provide value

Yes No

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Please upload the protocol provided

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Upload file

Protocol/Project title

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Protocol/Project short title

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Do you have a DUHS protocol number?

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Yes No

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IRB number

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Primary Funding Source

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Specify other funding source

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Fund Code

How soon do you need someone to start working on your project?

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M-D-Y

Number of Participants

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Participant Type

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Healthy Volunteers

Adult

Pediatric

Pediatric age

* must provide value

Less than 1 year

1-5

6-11

12-18

Therapeutic Target Area

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Specify other therapeutic type

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Approximate Service Duration

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Duration

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Weeks Months Years

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Study Phase

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Specify Other Phase

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Please check all the interventions that apply

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Behavioral

Biologic

Chemo

Drug

Device

Other

Specify Device

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Specify Other Intervention

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Services Requested

See DOCR and DEPRU Service Center Rates

* must provide value

Coordination

Advanced Practice Provider

Lab

Nursing

Project Management

Recruitment

Regulatory

Spanish Interpretation/Translation

Exam room use only

Coordination Service Required

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Inpatient

Outpatient

Other research visits

Confinement

Remote (ex: data management, follow up phone calls)

Lab Services Required

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Lab and leave

Lab processing & Shipping

DEPRU safety labs

DCAL Safety labs

Has a lab manual been provided?

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Yes No

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Please upload the lab manual provided

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Upload file

Are your visits outpatient, confinement, or both?

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Outpatient

Confinement (overnight)

Both

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What is the total number of outpatient visits?

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Will you need the outpatient visits to take place over the weekend?

* must provide value

Yes No

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How many confinement visits for the duration of the study?

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How many nights per confinement visit?

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Number of expected participants per confinement visit?

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Will you need the confinement to take place over the weekend?

* must provide value

Yes No

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What services do you need assistance with recruitment for?

* must provide value

Assist with creation of email template

Creation of Target List from Volunteer Database

Creation of recruitment plan

Create telephone script

Conduct telephone screens

Email Blast

Schedule screening visits

Create advertising materials

When are services needed?

* must provide value

Weekday (M-F, 8:30am-5pm)

Evenings/Overnight

Weekends

Special equipment required

* must provide value

None

Vital sign machines

Otoscope

Glucometer

Dash monitors

Electrocardiogram machine

Infusion pumps

Stadiometer

Scales

Suction pump

Automated external defibrillator

Different infusion pump

Special tubing

Other

Specify other equipment

* must provide value

Participants physical limitations

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None

Mobility limitations requiring wheelchair

Physical limitation requiring lift machine

Visual limitation

Hearing limitation

Fall Risk

Other

Specify other limitations

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Does protocol require any ancillary services?

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Yes No

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Do any of your study visits include administration of investigational product?

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Yes No

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Which of the following types of investigational products will you need administered?

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Infusion

Oral medication

Injection

Other

Specify Other

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COVID-19 Study

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Yes No

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Additional Comments

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