TrialWire Site Data - AZORA-AT193-NP - TrialWire Rapid Patient Recruitment

Are you adding a(Required)

Study Coordinator or Site

Azora or CRO team member (DC)

Study Name/ID

Name(Required)

First Last

Email(Required)

Any notes? For example does a person need to be deleted from the TrialWire Recruitment Dashboards?

Site ID Number(Required)

Site Name(Required)

Study Coordinator name(Required)

First Last

Study Coordinator Email(Required)

Do you need more than 1 email on the Platform receiving referrals?

Yes please

2. Study Coordinator name

First Last

2. Study Coordinator Email

3. Study Coordinator name

First Last

3. Study Coordinator Email

Any notes? For example does a person need to be deleted from the TrialWire Recruitment Dashboards?

Phone (this won't be used by patients - just admin if necessary)

Site Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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