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IIMS/CTSA Service Request Form

If you are requesting biostatistical assistance, please use the form located here - https://redcap.uthscsa.edu/REDCap/surveys/?s=k4Jx87zfkK

Contact Information

First Name *

Last Name *

Phone *

Email *

Title

Administrative Staff

Research Staff

Investigator/Researcher

Resident

Fellow

Trainee (K12 or T30)

Student

Other

Degree (may pick more than one)

DDS

Dr.PH

Ed.D.

MPH

MSC

MSN

OTD

PharmD

PhD

PsyD

ScD

Other

Institutional Affiliation

Institution Affiliation *

UTHSCSA

UTSA

Christus Santa Rosa Children's Hospital

San Antonio Metro Health District

South Texas Veterans Health Care System

Southwest Foundation for Biomedical Research

University Health System

Other UT System Components

UT School of Public Health Regional Campus in San Antonio

Service Areas Required *

Administration

Biomedical Informatics

Biostatistics and Study Design

Clinical Research

Clinical Research Ethics

Community Engagement

Training|Education and Training

Novel Clinical and Translational Methodologies

Other

Pilot and Clinical Studies

Single Point of Contact

Request Description *

Date of Request *

Month

Day

Year

Point of Contact

(e.g., Someone that may be more accessible than the requestor for follow up)

First Name

Last Name

Phone

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