Please consult with a trial statistician before completing this form. Nominated Persons and date of request Nominated persons are trial members who the NCTU are to accept service related requests from: Contact Details of Main Contact Randomisation Details Full title of trial: Trial acronym: Trial Sponsor: Trial Funder: Is the trial a PhD project? Yes No University of External Nottingham or external Fellowship studentship If yes, what is the funding source? Part of a larger project Other If specify Estimated Expected date of 1st Trial duration: Last Patient randomisation: Last Visit: Single Multi Single or Multi-Centre: If Multi, number of sites ____ Parallel Group Factorial Design of trial: Other Cross Over (specify)
Please consult with a trial statistician before completing this form. Nominated Persons and date of request Nominated persons are trial members who the NCTU are to accept service related requests from: Contact Details of Main Contact Randomisation Details Full title of trial: Trial acronym: Trial Sponsor: Trial Funder: Is the trial a PhD project? Yes No If yes, what is the funding source? University of Nottingham or external studentship External Fellowship Part of a larger project Other If specify Trial duration: Expected date of 1st randomisation: Estimated Last Patient Last Visit: Single or Multi-Centre: Single Multi If Multi, number of sites ____ Design of trial: Parallel Group Factorial Cross Over Other (specify)
wpd-15-1-randomisation-request-form-final-version1.1-05-jul-2016-1.docx