Download CancerClinicalTrialsUpdateForm

Cancer Clinical Trials Update Form
Please select one of the following:
□ Add Clinical Trial
□ Update Information on Existing Clinical Trial
□ Remove Clinical Trial
Please provide as much information as you have in these categories:
Protocol ID:
(Please enter the NCT ID)
Cancer Type:
Trial Phase:
□ Adult Only
□ Pediatric Only
Study Type:
First
Last
Doctor’s Name:
Drug Used:
Contact Information:
Submitted by: _______________________________________________________________
Phone number: ______________________Email address: ____________________________
Date: ____________________