C-Tract Study Site Questionnaire
KEY PERSONNEL CONTACT INFORMATION
Address
City
State/Province
Zip/Postal
Country
First and Last Name
FINANCIAL CONTACT INFORMATION

FACILITY INFORMATION

Please list the Primary Hospital at which you plan to enroll patients, as well as up to two major affiliate hospital that fall within your IRB’s jurisdiction.

RESEARCH COORDINATOR INFORMATION
First and Last Name
ENDOVASCULAR THERAPY (EVT)
First and Last Name
MEDICAL AND COMPRESSIVE PTS THERAPY
First and Last Name
VENOUS ULCER CARE
First and Last Name
SITE-SPECIFIC ENROLLMENT AND DATA COLLECTION
COMPETITIVE ENROLLMENT
STATEMENT OF CLINICAL EQUIPOISE