Clinical Trial Submission Form

Trial Name

Which locations are you recruiting in?

Auckland

Wellington

Christchurch

Dunedin

Other

Study Type

Interventional

Observational

Other

Participant Eligibility Criteria

Study Visits

Participant Reimbursements

Recruitment Start Date

Please let us know the date this trial should be deleted from the webpage if known

Application Email

Application Phone Number

Application URL

Lead Investigator Name

Lead Investigator Email

Lead Investigator Phone Number

Is this being submitted by the Lead Investigator?

Yes

No

Name of Submitter *

Submitter Email *

Submitter Phone Number *

In submitting the information above I confirm the above is true and accurate. I give consent to NZSG to publish the information on their website*