IRB Consultation Request Form

Instructions: Please provide the information below to request a consultation with an IRB expert. IRB staff will try to schedule consultations within 5 business days.

*Indicates required information

Requester Name: *

Requester Email Address: *

Requester Phone Number: *

Is this your first project to be reviewed by the IRB? *

Yes

No

Are you the Principal Investigator for the project? *

Yes

No

Is this consultation regarding a project that has already been submitted to the IRB? *

Yes

No

If yes, Protocol Number: *

Is this consultation regarding whether this project constitutes quality assurance/improvement?*

Yes

No

Is this a multi-site project?*

Yes

No

Please select from below why you are requesting a consult (select all that apply): *

Other - Please Describe: *

Consultation Scheduling

IRB staff will try to schedule consultations within 5 business days; however, if a different timeframe is needed or there are scheduling restrictions that our office should work around (e.g., clinic duties, teaching obligations, etc.), please let us know. Consultations are typically scheduled for 1 hour. If you believe additional time will be needed, please describe this in your response.

To help with scheduling, what days and times will work best for you? *