Clinical Trials Intake Form Header Image

Please fill out this form in order to add your clinical trial to Rush's website. You must complete a separate form for each trial for which you are currently enrolling subjects. Your submission will be reviewed by Antonio DeMarco (Antonio_S_DeMarco@rush.edu), then entered into a database of clinical trials on the Rush website by Michael Gallagher (Michael_J_Gallagher@rush.edu). You will be notified once the clinical trial has been added to the website. To remove the trial from the database when you are no longer enrolling subjects or to update information about the trial, please send a follow-up e-mail to Antonio DeMarco and Michael Gallagher.

This won't be displayed on the website. We will email this person if we have questions about the submission, and we'll let this person know when the trial is up on the website.
Would you like additional people to receive the confirmation email for this submission?*
Would you like additional people to receive the confirmation email for this submission?*
Please include credentials.
To select multiple, hold down Ctrl and click. If you don't see your department, select "Not Listed" and add your department in the Comments box at the end of the form.
To select multiple, hold down Ctrl and click.
Please include a contact phone number, email address, or both. This will be displayed on the website.
Please include a contact phone number, email address, or both. This will be displayed on the website.
Enrollment End Date (if available)
Is this clinical trial available at Rush Copley Medical Center?*
If the clinical trial is also available at Rush University Medical Center, please provide the ORA#. If not, leave this field blank.
Do not use the protocol title or include information the sponsor may consider confidential, such as the compound name or #.
400-word limit; information should be general and should not include information the sponsor may consider confidential, such as the compound name or #. More specific details may be posted if the sponsor provides written authorization.
List top four only; restrict to criteria you wish to see on the website to help potential participants prescreen themselves.
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