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Clinical Trial site
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1. In which area or the portal would you like to appear?
Clinical Trial Sites
2. Enter the name of the Clinical Trial Site or Service Provider - Organisation Name
3. Enter the contact name for this Clinical Trial Site or Service Provider - Contact Person
4.Select the language of the main content of the item. If the language does not appear in the list, please select 'Other'.
5. If you selected Queensland Health as the Organisation name, please provide your QH Facility ID
6. If you selected Queensland Health as the Organisation name, please select your Hospital and Health Service (HHS).
7. Services Offered by your site
Pre-clinical device design
Clinical trials CRO
Complementary medicines clinical trials
Clinical trials site
Full service CRO
Phase 1 unit
Investigator Initiated Trials
Trial Patient Recruitment
Treatment of patients
Completion of study documentation as per ICH GCP and contract
8. Main Service Category
Clinical Development Consulting
Clinical Research Organisation
Clinical Trial Administration
Clinical Trial Insurance
Clinical Trial Site
Comparator Drug Supply
Contract Research Service
Digital Services Marketing
Industry Peak Body
Intellectual Property Protection
Licensing and Commercialisation
Statistics and Data Development
Tax and Regulatory Advisor
Training and Education
Contract Manufacturing Organisation
9. Please provide the short promotional description of your Clinical Trial Site or Service for marketing purposes.
10. Clinical Trial Site or Service Provider person - Title
11. Clinical Trial Site or Service Provider contact person - First Name
12. Clinical Trial Site or ServiceProvider contact person - Last Name
13. Contact person email address
14. Contact person phone number
15. Your Clinical Trial Site or Service Provider web site address
17. Street name and number
18. Additional address information
23. Life Sciences Queensland (LSQ) Member
24. GPS location of your Clinical Trial Site or Service Provider- GPS Location 1
25. GPS location of your Clinical Trial Site or Service Provider - GPS Location 2
26. Please select the Clinical Trial Site Facility's department
Women’s and Family
27. Please provide the list of Therapeutic Areas for your Clinical Trial Site Facility: (Select all relevant)
Bacterial Infections and Mycoses
Congenital, Hereditary and Neonatal Diseases and Abnormalities
Digestive System Diseases
Disorders of Environmental Origin
Endocrine System Diseases
Female Urogenital Diseases and Pregnancy Complications
Hemic and Lymphatic Diseases
Immune System Diseases
Male Urogenital Diseases
Nervous System Diseases
Nutritional and Metabolic Diseases
Pathological Conditions, Signs and Symptoms
Respiratory Tract Diseases
Skin and Connective Tissue Diseases
Wounds and Injuries
28. Please list any sub-therapeutic areas.
29. Any other areas of expertise?
30. Study phase capabilities of your Clinical Trial Site
Device Post Approval
31. Does your Clinical Trial Site have the capacity to conduct Clinical Trials involving GMOs?
32. If yes, which of the following? (chose all that apply)
GM products that do not contain live GMOs
Modified human somatic cells
Clinical trials involving other types of GMOs
33. If you selected other in the previous question, please specify which other types of GMOs .
34. Do you have Affiliated Research Sites or Satellite Sites/Clinics? A Satellite Site is a secondary location where the investigator sees clinical trial subjects. Usually, this is the same investigator who sees subjects at the primary site location.
35. If you selected Yes for the previous question, please list where
36. What study types does your Facility have experience with?
37. If Other was selected, please indicate which study types.
38. Is your Facility affiliated with a government agency or part of a government funded health service?
39. Patient Population Demographics: (Select all that apply)
Adolescents/Adults 16 and onwards
Adults 18 and onwards
Geriatrics 65 and onwards
40. Are there any notable factors relating to your Patient Population (e.g. ATSI population local ethnic/cultural groups)
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