ClinicEval Connect- Patient Advocacy Group

Patient Advocacy Group

Question Title

* 1. Please provide the following demographic information for your organization

Organization Name

Organizational Disease or Disorder of Interest

Survey Respondent Name

Survey Respondent Title

Organization Website

Address 1

Address 2

City/Town

State/Province

Zip/Postal Code

Country

Survey Respondent Email Address

Survey Respondent Phone Number

Question Title

* 2. Cliniceval Solutions is an organization established to connect clinical trial stakeholders (doctors, pharmaceutical and medical device companies, research organizations and patient advocates) in order to expedite the development of novel therapies for patients in need. Our relationships and network with all stakeholders is extensive.

Please provide a summary of your organization's needs below. While we are not a funding organization, our team pledges to work on your behalf to leverage the network of clinicians and sponsors contained within our global database, CliniEval Connect, to help meet your objectives.

Once we review your request, someone from the Cliniceval Solutions team will contact you to discuss our ability to meet your request.