Become An Investigator
Do you want to be contacted to participate in clinical trials?
If clinical trial training were provided would you participate in clinical research?
First Name:
MI:
Last Name:
Credentials (check all that apply):
MD
DO
DPM
PA
Phd
Other
Medical License #:
Medical License State:
Specialty:
Cardiology
Family Practice
Internal Medicine
Other
Specify:
Practice Type:
Solo
Single Specialty
Multi-Specialty
Address:
City:
State:
Zip:
Work Phone
Cell Phone:
Email:
Fax Number:
Research Coordinator Name:
Research Coordinator Email:
Research Coordinator Phone:
What is the best day to reach you?
Mon
Tue
Wed
Thur
Fri
Sat
Sun
9-12pm EST
12-3pm EST
3-6pm EST
How many clinical trials have you participated in as a Principal Investigator?
Do you have Standard Operating Procedures (SOPs) in place at the practice?
In what type of trials have you participated?
Please indicate your role(s) in clinical trials if any:
DSMB
IRB
Clinical Advisory
Other
Specify:
How do you recruit  patients? 
Medical Records
Clinical Charts
Referrals
Other:
Specify:
When is the best time to reach you? (time will be adjusted to your time zone):
Estimated the average number of patients you see monthly:
Number of patients in practice:
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How many clinical trials have you participated in as a Sub-Principal Investigator?
6-9pm EST
6-9am EST

CONTACT INFORMATION
Columbus Research & Wellness Institute
8342 Veterans Parkway Suite 200
Columbus, GA 31909
Phone: 706-653-0419
CANCELLATION/NO SHOW POLICY
If you are more than 15 minutes late, your appointment may be shortened or rescheduled.  All appointments must be cancelled 24 hours in advance.  Appointments not cancelled 24 hrs. in advance will result in a $25 charge.  “No show” appointments will be charged the full cost of the visit whether prepaid or pending payment.  After “No Shows” future appointments must be pre-paid before scheduling.  CRWI Services are non-transferable and non-refundable.
Columbus Research & Wellness Institute
CRWI
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