Page 477 - eBook Version 8 Book 1 of 2 JUL 2022

PRE-TRIAL FEASIBILITY QUESTIONNAIRE
Date: ______________
Section 1: Study Information (section completed by PI and Research Team)
Study Title:
Section 2: Study Investigator Details (Section completed by PI and Research Team)
Is this a multi-site study?
☐ Yes ☐No
If “Yes” Complete section 2a, If “No” skip to next section 2b
Section 2a
Investigator Name
Primary Research Coordinator Name & Contact Information:
Primary Administration Coordinator Name & Contact Information:
Study specific Questions (Section completed by PI and Research Team)
What is the disease condition under study?
In the past year, how many patients were seen at Children’s Health with this condition?
Funding (Section completed by PI and Research Team)
Section 3a
1. How is the project funded:
☐ Internal/Departmental (UTSW) ☐ Academic (sub-contract)
☐ Federal/State
☐ Industry
☐ Other
2. Name of Funder
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