Clinical Trials Information
Fill out the form below to request more information.
Please fill all required fields (*).

All information will be kept confidential.

The automated web form is currently down. Please manually email us the following information to
Kathleen.Kavlick@uhhospitals.org with the subject line Request for Clinical Trial Information
(red indicates required field)
*First Name:
Middle Name:
*Last Name:
Address 1:
Address 2:
*City:
*State/Province:
*Zip/Postal Code:
Country:
Daytime Phone:
Evening Phone:
Clinical Trial of Interest:
*Email:

Thank you for your cooperation!