CCRhub Membership

Are you a licensed and practicing Physician interested in a Membership in CCRhub? The benefits are numerous:
• Efficient clinical information gathering,
• Improved information delivery to provide timely identification for clinical trial candidates,
• Proprietary Improved Industry Processes to maximize your incentives,
• Unique Company strengths creating a greater opportunity for you,
• Collaborative efforts by clinicians, clinical research companies and organizations, and patients to improve clinical research information collection, clinician utilization, and outcomes.

Membership Interest Questionnaire
Please fill out the following Questionnaire and click ‘Submit’ so we may evaluate you for potential Membership. Thank you for your interest in CCRhub!

All fields are required.

Contact First Name:
Contact Last Name:
Title:
Facility Name:
Group Name:
Street Address:
Address 2:
City:
State:
Zip:
Phone:
Fax:
Email:
Website:
Number of physicians in Practice?:
Specialty:
Currently involved in Clinical Trials?
Have you done clinical trials in the past?
If Yes, how many in the past five years?
Do you have an EMR? Please list name:
Do you have a PM System? Please list name:
Do you have a Network Administrator? If so, please list name and contact info:
Best Method of Contact with info:
How did you hear about us? (if Referral, please list name and Facility Name):

Comments or Questions:

Please click on the button ‘Submit’ once, and a CCRhub representative will contact you.

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