Submit a concept IIS proposal

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Investigator name

Name of institution

Address

Telephone

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Study title

Study design (short description)

Main objective*

Secondary objectives*

Indication to be investigated*

Study population*

Number of patients to be enrolled*

Short description of statistics including a justification for the number of subjects to be enrolled*

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Product(s) to be investigated and (if applicable) comparator(s)

Study duration (how long will each patient be treated and followed up?)*

Planned start date (first patient enrolled)*

Planned end date (last patient completed)*

Requested support

Please also enclose your study synopsis

Please describe how your study will add value to the existing evidence on this topic/area

By checking this box I accept that the Global IIS Committee from Mölnlycke Health Care may contact me via the e-mail address or phone number that I provided when submitting my application.

Submit a concept IIS proposal

Concept IIS proposal

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