Investigator Registration Form    
Investigator First Name:
Investigator Last Name:
Name of Institution:
Phone Number:
(Please include country code)
Fax :
(Please include country code)
Email :
Type of Hospital :
(e.g. Supespeciality / Muti speciality Hospital (Private /Govt))
Medical Specialisation :
(e.g. generalist please put internal medicine, family practice)
Indicate if you have a sub-specialisation? :
Main therapeutic area of interest in terms of Clinical Trials :
(e.g. Cardiology, Opthalmology)
Patient age groups do you treat :
(e.g.Paediatric, Adult)
Specific areas of interest for clinical trials, in terms of indications / therapeutic areas:
(e.g. Cardiology, Opthalmology)
Studies conducted :
(Indication/Therapeutic Area)