CIU Consultation Request Form
Investigators are strongly encouraged to submit a CIU Consultation Request form in advance of submitting their formal application to the REB.
Please complete the following form and attach your protocol or other supporting documents you wish to share for the CIU’s consideration. For any questions regarding the CIU Consultation Request Form or working with the CIU, please contact Julia Chehaiber, Senior Operations Manager, Clinical Epidemiology Program (jchehaiber@ohri.ca or 613-737-8899, 75142).
* required fields
Principal Investigator (PI) Name *
required
Study Coordinator (CIU or Non-CIU) *
required
TOH Department/Division *
Department
required
Division
required
Brief Protocol Title *
required
Attachment *
(Only one file allowed; max size 20 MB. If you have multiple documents, please attach as a .zip file. Permitted file types include extensions .doc, .docx, .pdf, .jpg, .jpeg, .bmp, .png, .gif, .txt, .zip)
required
This file type is not permitted to be uploaded.
Your file exceeds the maximum size of 20 MB.
Funding Source * (check all that apply)
required
What is the approximate start date (month/year) for using CIU's services? *
required
What Phase is the trial you wish to conduct at the CIU? *
required
Is there any other information the CIU needs to know, or do you have any specific questions you wish to submit?
