Request for Proposal

We are always ready to focus on your patient recruitment and retention needs.

Whether your team is just getting started, or has a clinical study in need of rescue, we will develop a patient recruitment - retention proposal based on a careful assessment of your study’s needs, its target patient population and feasibility evaluation.

Please complete the RFP form below and click the “Submit RFP” button to directly send your RFP request to MediciGlobal.

If you would like to discuss your RFP by phone, please contact Liz Moench, MediciGlobal President at +1 610 659 5093.

Request For Proposal Form

Contact Information (PART 1 OF 3)*required fields

Sponsor First Name:*
Contact First Name:*
Contact Last Name:*
Contact Title:*
Address 1:*
Address 2:
City:*
State/Province:*
Zipcode:*
Country:*
Contact Phone Number:*
Best time to call:
Contact Fax Number:
Contact E-mail Address:*
Preferred Method of Contact: Phone Email

Proceed to PART 2

Study Timelines (PART 2 OF 3)

Services Requesting:*
Control+Click to select multiple
Proposal Due Date:*
MM/DD/YYYY
Short Study Name and Indication:*
Study Phase:*
Number of Hard Copy Proposals:*
Estimated Start Date of Study:
MM/DD/YYYY
Study End Timelines:
1. Estimated End of Recruitment & Recruitment Period:*
  MM/DD/YYYY
2. Treatment Length
3. Follow-up Length
First Patient In Date:
MM/DD/YYYY
Last Patient Out Date:
MM/DD/YYYY

Return to PART 1

Proceed to PART 3

Study Details (PART 3 OF 3)

Site Totals:
1. Total Number of Sites?
2. Total Number of US Sites?
3. Total Number of Non-US Sites?
If this study is in rescue, what recruitment advertising strategies have been implemented and how successful were they?
Number of Patients:
1. Total Number of Patients Screened?
2. Total Number of Patients Enrolled?
3. Total Number of Patients Evaluable?
4. If available please provide anticipated patient screening numbers:
What are your goals for patient recruitment and seeking a proposal from MediciGroup?
Shift+Click to select multiple
Other Goals:
IRB:
1. Central IRB:
2. Number of Sites Using Local IRB:
Patient Totals:
1. Patients Per Site?
2. Is there a cap on enrollment per site?
  Yes No
  If yes, how many?
Compound: Investigational Marketed
Sponsors Budget:
1. Recruitment
2. Retention
3. Study Coordinator

Return to PART 2

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