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Basic Circle Request Form

What is the Name of your Study?

Clinical Objectives of your Study

Who is the Principal Investigator?

What is the name of the Institution/Clinic that will be conducting the study

How Do You Prefer to Enroll Patients?

Patient Enrollment Options (Multiple Choice)*

Would you like to capture Custom Patient Consent with the help of Benchmarc™?

If no, generic consent will be used. See more on Patient Consent.*

What is the Study’s Primary Endpoint?

Please share the URL to one or more sources
Please indicate how often will you follow up on your assessment? (days, weeks, months)

What is the Study’s Secondary Endpoint?

Please share the URL to one or more sources
Please indicate how often will you follow up on your assessment? (days, weeks, months)

Any Custom Questions?

1) Please download the template and fill in the necessary information.

Any special request to your Circle?

Do you need help or counselling?

Please contact your account manager or write us an email.