A clinical research questionnaire is an effective method used to collect the required data on certain clinical tests or trials for suggesting the effective remedial measures and improvements in the existing clinical drugs or procedures. In this questionnaire, the clinical administration is the concerned department who initiates and accomplish such a research questionnaire as per the requirements of the concerned pharmaceutical firm.
Sample Clinical Research Questionnaire:
Name of the sponsor: _______________
Address of the sponsor: ______________
Contact number: ___________________
Protocol number: __________________
Trail Date: ______/_______/_______
Q1. What kind of clinical research is this?
Q2. Is this clinical research based on the official EC and ICH guidelines?
Q3. Please choose the base of this clinical research?
- Drug trial
- Treatment trial
- Surgical trial
- Others, please specify: _____________
Q4. Choose the therapy area for the above selected drug or treatment clinical research.
- Blood disorder
Q5. Is the above mentioned clinical treatment or drug involving any of the following mentioned elements?
- Silicone implants
- Hormone replacement therapy
- Blood products
Q6. Does this clinical research study cover any of the following?
- Tissue technology
- Cell technology
Q7. Does the above mentioned drug or treatment have ever been uses for conducting a clinical research?
- If yes, please specify the results: ______________
Q8. Do all patients sign an approval consent form?
- Not all
Q9. Does this research involve children, old people and pregnant ladies?
Q10. What are the expected side effects going to be covered with this clinical research?
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