FHI Clinical Site Survey

| Resume a previously saved form
Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

FHI Clinical Logo
Thank you for providing information about your research site. This survey is used for sites in various countries with different disease experiences. if some questions are not applicable for your site, they can be skipped. If you have questions or need help completing this survey, please contact jtoro@fhiclinical.com
Site Information




Site Contacts







Address Information









Disease Experience

Please provide information about the site's trial experience with specific diseases. If you have multiple expertise areas, please consider listing at a minimum your top three areas. You can add experience related to additional diseases by clicking "Add Experience" in the bottom right.
Site Experience














Vaccine Experience







Additional Disease Information

If there are additional diseases in the site area that the site does not have experience with, please list them here.
Disease Prevalence







EPI Vaccine Schedule

EPI Information



Facilities

Site Facilities



Lab Capabilities




Lab Certification



Training

Site Training


Awareness of Availability


Approval Bodies

Regulatory Information




Overall Performance

Challenges and Opportunities