WELLCOME TRUST CLINICAL RESEARCH FACILITY
CRF BOOKING REQUEST FORM
Please fill in the following fields and email back to the WTCRF at wtcrf@bch.nhs.uk:
NOTE: Booking requests will only be accepted via email. Please do not submit printed booking
forms. One form to be completed per patient (or monitor/CRA). Please use separate forms for split
appointments.
Booking Details: (Note: CRF Admin staff will input appointment details into Lorenzo)
Patient Name:
Hospital No:
Monitor/CRA:
Organization:
Study Name:
/
Appt. Date:
Time:
Start:
/
:
:
End:
Do you require CRF to request hospital notes?
Please select.. (if so, please state for which
patients)
Do you require CRF to issue appointment letter?
Please select..
Do you agree to the Terms & Conditions of the booking?
(See next page)
Please select..
Facilities Requested:
Rooms Requested:
(Please check boxes)
Non-clinical
consultation room
Day-bed*
Please select...
Please select...
Outpatient room
Metabolic lab
Support facilities requested:
Analytic laboratory
Treatment room
(Please check boxes)
Metrology room
Bone densitometer
For TCIs:
Date Decision to Admit:
Admission type:
/
/
Please select..
Starvation
If overnight,
duration
Treatment or Procedure:
Additional Information:
Form Completed By:
Name:
Designation:
Department:
Ext number:
WTCRF Booking form Version 2.3 October 2013
Please select..
days
CRF Use only:
CRF facilities available?
Please select...
Study code:
CRF Manager
Lorenzo
Letter
Confirmation of booking
Terms and Conditions of Booking:

The use of the WTCRF is restricted to research purposes only. Bookings for patient
attendances will only be accepted if associated with a research study which has received
WTCRF Scientific Advisory Committee approval. Other requests will be addressed on a
case-by-case basis.

Facilities will be allocated on a first come first served basis and the WTCRF Staff will
accommodate requests where possible.

Booking forms are not required for pre-booked research clinics.

Bookings can only be made on the receipt of a completed booking form. Completed forms
should be emailed to wtcrf@bch.nhs.uk

The WTCRF will aim to respond to your request within one working day (Mon-Fri).

Confirmation of the booking will be sent to the requester by email. If your request can not
be accommodated, you will be notified and where possible offered an alternative.

The facility is open between 8am-6pm Mondays-Thursdays and 8am-4.30pm on Fridays.
Bookings made outside of these times should be agreed in advance with the allocated lead
nurse on the WTCRF.

If you wish to cancel a booking, please inform the WTCRF by phone on x9550 or by email
on wtcrf@bch.nhs.uk as soon as possible, but at least 24 hours prior to the booking.

To ensure efficient use of WTCRF resources, all bookings must start and end at the times
specified on the booking form.

Users must indicate all facilities required on the booking form.

The WTCRF will provide standard ward/outpatient equipment and consumables. Users are
expected to provide non standard items.
Please note that by making a booking with the WTCRF, you are agreeing to the following:

All staff working within the facility will comply with the WTCRF Operational Policy and
standard operating procedures and will be accountable to the Clinical Manager.

Completed WTCRF outcome sheets are to be returned to reception for all patient
attendances.

All private and confidential information is to be handled in accordance with the Data
Protection Act and Caldicott guidelines.

WTCRF nursing and admin staff will be permitted to support activity within the facility.

All rooms/areas will be left clean and tidy and all furniture returned to their original positions.
All paperwork and non WTCRF equipment and consumables are to be removed from
clinical areas after use.

No WTCRF equipment or furniture will be removed from the facility without the prior
authorization from the Clinical Manager/Ward Manager.

All equipment / consumables brought into the WTCRF will be removed following the
booking unless agreed by the Clinical Manager/Ward Manager.

Report any problems with equipment so that they can be rectified as soon as possible.

Accidental spillages or damage are to be reported to a member of WTCRF staff straight
away to ensure that spillages can be cleaned up and damage fixed as soon as possible.

Failure to agree and act to T&C of booking may prevent future bookings.