This form needs to be submitted electronically to Mrs. Hilde Nevens, clinical trial coordinator
– hilde.nevens@stlucas.be
Investigator :
Study title :
Type of study :
Clinical trial company sponsored - Phase
Sponsor (company):
Non-commercial clinical trial - Phase
Sponsor (university, p hysician …):
Non-interventional trial company sponsored
Sponsor (company):
Non-commercial non-interventional trial
Sponsor (university, p hysician …):
Retrospective analysis of medical files:
Sponsor:
Other:
The following services will be involved in the trial:
Coordination clinical trials
Nursing support
Mrs. Hilde Nevens (+32 50 36 57 11)
Mr. Tom Durnez (+32 50 36 58 75)
Mrs. Ann Vermeire (+32 50 36 58 76)
Mrs. Sophie Vancauwenberghe (+32 50 36 58 77)
Pharmacy
Laboratory
Radiology
Pathology
Other:
Mrs. Nancy Kimpe (+32 50 36 58 78)
Mrs. Anneleen Spriet (+32 50 36 54 78)
Mrs. Stefanie Soen (+32 50 36 54 77)
Dr. Johan Robbrecht (+32 50 36 53 40)
Mrs. Ann De Baets (+32 50 36 53 56)
Dr. Pieter Vandaele (+32 50 36 54 16)
Mr. Frank Welvaert (+32 50 36 53 95)
Dr. Ignace Dalle (+32 50 36 53 40)
There will be no need for support from personnel or services from AZ Sint-Lucas Brugge.