Physicians | Clinical Trials, Medical, and Therapeutic Consulting by Hyperion Clinical Research, Charleston, WV

Therapeutic Area(e.g. Cardiovascular, Neurology, Oncology, etc.)

Indication

# Patients planned?

# Patients enrolled?

Enrollment period?

Hyperion Clinical Research | connecting patients to new scientific research

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HYPERION CLINICAL RESEARCH, LLC

1206 Virginia Street East, Suite 202
Charleston, WV 25301
Phone: 304-345-2880
Fax: 304-345-2883

Julie H. Mobayed
Director, Clinical Management
jhm@hyperionclinicalresearch.com

Natalie H. Tappe
Director, Clinial Operations
nht@hyperionclinicalresearch.com

If you are interested in participating in clinical research please complete this form:

Investigator Name:
Sex:	Male Female
Degree:	MD MBA DO DPM PharmD
	OD DMD PA Phd RN
Areas of Board Certification:
Institution:
Dept / Division:
Address:
City, State, Zip:
Telephone:
Fax:
Contact Person:
Contact Phone:
Contact Fax:
Email:
Type of Practice: (Check whichever may apply)
Hospital /Clinic
Hospital/ Academic/ University
Group Private
Is entire group interested in participating in group trials:	Yes No
Private Practice

POPULATION
Please indicate the number of patients that were seen over the last year?
Pediatric:	Yes No
0 - 1 month:	patients
1 mo - 2 years:	patients
2 - 12 years:	patients
12 - 17 years:	patients
Adult(18-64)	Yes No
Number of Patients:
Male:	%
Female:	%
Geriatic(64+)	Yes No
Number of Patients:
Male:	%
Female:	%

RACE:
Caucasian:	%
African-America:	%
Asian:	%
Other:	%

IRB:
Can your site use an IRB?	Yes No
If no, what Local IRB does your site use?
What is the frequency of the meetings?	Everyweek Everymonth Other:

LAB FACILITIES:
Does your site have its own Clinical Lab?	Yes No
Can your site use a Central Lab in studies?	Yes No

AVAILABLE EQUIPMENT:
Oxygen
911
Staff Certified CPR
Crash Cart
Ambu-bag
Defibrillator
Emergency Medications
EKG Machine
Other Specify:

RESEARCH AREAS OF INTEREST:

CLINICAL TRIAL EXPERIENCE: Yes (continue below) No

CLINICAL PHASE EXPERIENCE (Please check all that apply):
Phase I Phase II Phase III Phase IV

Please list up to five (5) of the most recent clinical trials in which you have participated:

Comments:

Hyperion is a WV ELS Company