Essential Group Inc. | A Specialized CRO Delivering Success Through Therapeutic Expertise

	Request for Proposal Essential is ready to help you achieve success on your program. That starts by listening to your needs and challenges. Please contact Essential by email at for information or to discuss your program. You may also send a request below and you will be contacted. *=required fields
* Sponsor Name:	Today's Date:
* Sponsor Contact & Title:	Contact Address:
* E-Mail Address:	* Proposal due date (date proposal needs to reach sponsor):
Sponsor's Budget: $	# of hard copy proposals: Send Proposal to you by Email?
* Short Study Name and Indication:	* Study Phase:
* Estimated start date of study (first patient in, if available):	Enrollment window(date and/or # of months): Treatment Period: Follow-Up Period:
Total # of sites: Total # of US sites: Total # of non-US sites:	If rescue, total # of patients screened and randomized to date:
Total # of patients screened: Total # of patients enrolled: Total # of patients evaluable:	What are your goals for patient recruitment and seeking a proposal from Essential? (i.e. shorten enrollment period, contingency planning for future) :
Central IRB (please name): Number of sites using local IRB:	Patients per Site: Is there a cap on enrollment per site? If yes, how many?
Screen/Failure Rate: % Drop Rate: %	Is a patient stipend being provided? If so, how much? $
Compound:

Request for Proposal