Generate Stoelting Form

Generate Stoelting Form

Research Permission
Telehealth Administration Agreements

Complete All Information Below and Click 'Generate Research Agreement'

Name of Person Requesting Permission

Research Project Title

Institution Requesting Permission

Address of Primary Contact

Phone Number of Primary Contact

Email of Primary Contact

Enter Shipping Address

Enter Number of Sites for Research

Start Date of Research

End Date of Research

Enter Payment Method for Payment of Research Fees

List Any Modifications Researcher is Seeking

Indicate Numbers of Participants and Administrations

Indicate items needed- 15% research discount included

Indicate Languages for Translation

Complete All Information Below and Click 'Generate Telehealth Agreement'

Name of Person Requesting Permission

Institution Requesting Permission

Address of Primary Contact

Phone Number of Primary Contact

Email of Primary Contact

Enter Number of Sites for Telehealth

Start Date of Remote Administration

List Any Modifications in Addition to Remote Administration

Describe Remote Administration