Request a price quotation

In order to estimate the cost of database setup, configuration and data management services for web randomization, we require the following information.

** Please complete one copy of this form for each study estimate required.**

Project information

Project name or title

Type of study

Sponsor type

Estimate required for

Submission deadlineIf the estimate is for a grant application, please provide the submission deadline

Date estimate deadline

Contact information

Name (required)

Business Email (required)

Telephone

Institution/company

Country

How did you hear about us?

Project specifications

Number of anticipated subjects (study sample size)

Duration of database accessThis should include the duration from the start of the study to continued database access after the end of the last subject data collection. In months or years.

Number of usersEstimated number of users who will accessing the database for data entry, data management or coordination (including data entry personnel, coordinator and investigator)

Number of centers/sites

Setup

 Self-setup eCRF design by Dacima Both

If eCRF design by Dacima, copy of the study, randomization questionnaires or case report forms Provide the final or draft version

If not available, study description or estimate number of data entry fields (questions)Please provide as much detail as possible

Which modules do you need?

CDISC  Yes No

MedDRA coding Licensing not included  Yes No

WHODrug coding  Yes No

IWRS (Web randomization)  Yes No

Drug Management Allocation of treatment dispensing codes (drugs/bottles) to patients based on treatment arm and inventory and consignment tracking  Yes No

Schedule a demo

 Yes No

Additional information