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Clinical Trials

Dear colleague,

We are often asked to provide names and addresses of ICU doctors who could contribute to international clinical trials (on blood transfusions, new treatments of sepsis, management of stroke, …).
Such requests include not only the large teaching hospitals but also peripheral / community hospitals.
If you are interested in being included on such a list, please fill in this questionnaire.

Title | Mr Mrs Miss Prof Dr
First Name |
Last Name |
Address 1 |
Address 2  
Zip |
City |
State  
Country |
Phone |   Format (+countrycode areacode phone)
Fax     Format (+countrycode areacode phone)
Email |
University Affiliation
(if applicable) 		 
Type of ICU
(several answers possible) 		| Medical
Surgical
Trauma
Coronary
Pediatric
Burns
Number of ICU beds |
Number of admissions / year |
Type of Hospital | University
City
Community
Number of hospital beds |
Area of special interest
(several answers possible) 		| hemoglobin / transfusion
sepsis trials
stroke
All