Investigator Application Form

    Investigator Name:

    Investigator Address:

    If yes, please provide your Study Coordinator's contact information below.

    Study Coordinator Name:

    Study Coordinator Work Address:

    SECTION II: CLINICAL SITE QUESTIONS


    SECTION III: CLINICAL TRIAL QUESTIONS

    Do you foresee any logistical challenges with ensuring that study participants at your clinical site obtain the prescribed thoracic imaging and are assessed in clinic at the appropriate frequency?
    YesNo