Site/Site Network or Patients/Advocacy Template
A Template to Create a Draft Company Profile for Site/Site Network or Patients/Advocacy
Some teams prefer working with a draft before they are going to ClinEco and finalize their profile. It is completely optional.
It is suggested to fill the profile directly on the platform but if you need an extra layer of assurance, we have created the document below that includes all the fields that you would see on ClinEco’s Company Profile Form.
In order to save your work, all required fields* must be entered.
Company Name*
Company Alias*
Company Alias (this creates your unique URL within the ClinEco platform; e.g., clineco.io/your-company-alias)
What is your company's role in the clinical trial EcoSystem?*
- Clinical Trial Sponsor
- Clinical Trial Site/Site Network
- CRO
- Technology/Service provider
- Non-profit/Other
Number of employees*
- 1-10
- 10-50
- 50-200
- 200-500
- 500-5,000
- > 5,000
Year Founded (YYYY)* ____________
Company Headquarters
- Country*
- City*
- State
Company Branch Location
- Country
- City
- State
Ownership*
- Public Company
- Private Company
Optional
☐ Women-Owned
☐ Minority-Owned
Message for the EcoSystem
This is a summary about your company that will show up on your profile page, limit 1,500 characters.
My Affiliations on ClinEco
This section allows you to add up to five companies that you are affiliated with. You can select these companies from a dropdown menu, making it easy to showcase your connections within the platform.
What We Do
Investigational Products*
+ Add Product
Therapeutic Areas*
+ Add Areas
Indications
+ Add Indications
Who We Are
- Independent Site
- Site Network
Corporate website*
Research or Practice Settings*
Patient Care Settings*
Team Members (Max 3)
- Name
- Job Title
- Name
- Job Title
- Name
- Job Title
Patient Demographics
Age Group:*
Diverse Patient Population Including:*
Experience
Trial Geography*
+ Add Region
Languages*
Since what year has your company been active in clinical research?
# of Trials supported
Staffing
# of Co-investigators
# of Study Coordinators
- Dedicated Clinical Project Management
- ICH-GCP Training
Trial Phases Supported
- Any
- Phase I
- Phase II
- Phase III
- Phase IV
Laboratory & Equipment
IRB Status
IRB Type
How many days does it typically require from initialIRB submission to approval?
Electronic Data
- Worked with electronic data capture (EDC) before
- Support electronic consent
- Allow remote access to EMR for monitors
What electronic health record system is used at your institution?
The Search Card Preview button provides a preview of how your profile displays on the Search Page. This information is pulled from the Message for the EcoSystem section, Clinical Trial Services & Technologies tags, and the Investigational Products tags.
Note, the Message for the EcoSystem section allows you to input 1,500 characters. The search card truncates this to the first 700 characters, approximately 100 words.
