JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Quality Initiation Meeting Request Form
Please provide the following information to request a quality initiation meeting. An ORQA member will contact you shortly.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Person requesting quality initiation meeting:
*
Your answer
Reason for request of quality initiation meeting:
*
Your answer
Department:
*
Huntington's Disease
Infectious Disease
LCCC Oncology
Memory Disorders Program
Neurology
Radiology
Rheumatology
Transplant
Other:
Principal Investigator (PI):
*
Your answer
Study Title:
*
Your answer
Is the study IRB approved?
*
Yes
No
Study IRB #:
Your answer
Sponsor:
*
Your answer
When are you expecting ORQA to conduct this meeting?
*
Your answer
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Georgetown University.
Report Abuse
Forms
