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Surveys
2015
February
E
Event Adjudication - AstraZeneca
Event Adjudication - AstraZeneca
Supplier Survey Form
Event Adjudication
Last Day to Respond
12th February 2015
PRIVATE AND CONFIDENTIAL
0%
Exit Survey
Application Information:
Please review all sections of the form and provide answers in accordance with the request and where applicable. We would appreciate if you could provide all information requested in the attached format in the order requested, in the column of answers.
In case you feel the information asked for in the form is confidential and proprietary, we are willing to provide you with a Non Disclosure Agreement (NDA) for the same.
Please note Your participation in the survey is completely voluntary. The survey is an initial market assessment and not a live RFI process. Not responding to the survey in no way shall impact the current and future relationship with our client.
Conditions:
Please feel free to mention or clearly explain any and all assumptions, conditions, exceptions or limitations imposed by or included in this form.
Obligations:
Beroe will not bear any obligation or responsibility to any person for any issuance of this supplier survey form. Any costs incurred by the supplier in responding to this inquiry or activities associated with this form should be borne by the supplier and will not be reimbursed by Beroe Inc.
*
Company Headquarters:
*
Year in Business:
Employee Strength:
2013
2014
2015 (E)
Employee Strength
Revenue:
2013
2014
2015 (E)
Annual Revenue
Revenue from Clinical Adjudication
Remarks:
Geographical Capabilites:
North America
Latin America
Europe
Asia Pacific
Middle East Africa
*
Do you have presence?
*
Do you provide Adjudication service?
FTE Details:
North America
Latin America
Europe
Asia Pacific
Middle East Africa
No of FTE
Utilization Rate
Provide No of Studies you have provided Event Adjudication Services (Count all studies not only active studies) by phase
No of Studies
Comments if any
Phase 1
Phase 2
Phase 3
Phase 4
Observational Studies
Provide No of Studies you have provided Event Adjudication Services (Count all studies not only active studies) by therapeutic area
No of Studies
Comments if any
Oncology
Cardiovascular
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