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?

  • Quantitative
  • Qualitative

Q2. Is this clinical research based on the official EC and ICH guidelines?

  • Yes
  • No

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.

  • Cardiovascular
  • Blood disorder
  • HIV
  • Cancers
  • Gynaecologist
  • Vaccines

Q5. Is the above mentioned clinical treatment or drug involving any of the following mentioned elements?

  • Nicotine
  • 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?

  • Yes
  • No
  • If yes, please specify the results: ______________

Q8. Do all patients sign an approval consent form?

  • Yes
  • No
  • Not all

Q9. Does this research involve children, old people and pregnant ladies?

  • Yes
  • No

Q10. What are the expected side effects going to be covered with this clinical research?