Juno Research, L.L.C.
Delivering High Quality Results
Registration
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  Please Provide the information requested below to be entered into our network of research
  physicians. Please complete and send. Field marked with * are required.
*Last Name:
*First Name:
*Title:
*Degree:
* Clinic Name & Mailing Address:
* Type of Investigator Practice:
(i.e,: Family Practice, Private
Practice, etc)
* Investigator Medical Specialty:
(i,e,: Pediatrics, Family Medicine
etc)
Please indicate the percentage of
your patient  population below.
(i.e,: Male, Female, Outpatient, Impatient,       
Intensive Care, African Am,Caucasian,             
Asian, Hispanic, Infant, Child, Adolescent,      
Adult and  other.)
* Research Phase Experience:
(i.e,: Phase I, Phase II, Phase II, or          
Phase IV.)    
From which source(s) do you           
typically enroll  most patients?
(i.e,: Patient database, Physician                       
Referrals, Advertising, etc
* Has the FDA ever audited your
research site?
(yes or no) if yes, was a 483 issue?.
Please explain.
If it doesn't apply in your case please
enter "NO Apply"
Please indicate which of the                 
following amenities you have               
available at your site.
(centrifuge, Clinical Laboratory, ECG,
Email access, Freezer -20ºC
Freezer -70ºC, Internet access, Micro Lab,
Pharmacy, Radiology,Respiratory Function
Lab, Secure Drug Storage, Secure Records  
Retention, Sleep Lab and Ultrasound.)
* Your Email:
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