You may schedule via this form at any time. If you have questions, please
contact Amy Marra, (847-2793), at the CRC, Monday through Friday, 8:00 a.m.
to 3:00 p.m.
scheduling your outpatient visits please fill out all
information under the appropriate column. Press the TAB key
to move from field to field.
Any visit involving controlled research meals must be scheduled at least
one week in advance. Other visits need to be scheduled at least one
business day in advance.
If a study needs to have samples shipped on the same day in which they are
drawn, the bloods must be drawn no later than 2:30 p.m. so that they can be
processed and be ready to ship by the 3:00 p.m. Fed-Ex deadline.
No subject may participate in any phase of a study unless there is
current signed informed consent on file at the CRC.
When the volunteer signs the consent form the CRC needs the original copy.
The patient may bring it with him/her or you can put it in the campus mail
to Joan Bertolet, CRC, Shepardson 2, MCHV Campus.
If the patient has a study ID or subject number, please
put in the Visit #/Test section.
The scheduler will reply back to you by e-mail either to
confirm or to suggest an alternative date and time if we
cannot accomodate that visit. You will also receive a copy of
your schedule request by email.
*** For CANCELLATIONS,
we have a simplified form (which may be used for outpatients and extended stay/outpatient bed visits),
please click HERE.
For CHANGES, please type "CH" and explain changes in
the Visit #/Test section.
Study ID(if applic.)
*** If the subject does not already have a MRN, please enter the following information:
Primary Care Provider
Enter any comments in the space provided below: