Depression and Bipolar Support Alliance
Clinical Trial Listing Form

Posting clinical trial information on the DBSA web site is free and is meant to serve as a resource. Posting trial information does not imply any endorsement by DBSA of the trial, the treatment(s) it is studying, its sponsors, or funders. Patients are encouraged to speak to their doctors before making any decisions about participating in a clinical trial.

Please submit the form below or print and fax it to (312) 642-7243. Generally, trial information will be placed on the site within three business days and will be posted until the deadline for enrollment. If trial information needs to be removed before the deadline, please submit request in writing. Information will be removed within three business days. If you have any additional questions please contact the Program Manager.

Date: -- mm/dd/yy

Please provide the following contact information for the person responsible for posting this trial information:

Name

Title

Organization

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Daytime Phone

FAX

E-mail

Trial Name:

Trial Sponsor:

Funder(s) of trial:

Contact person for enrolling in/information on trial:

Contact phone:

Contact email:

Trial web information:

Deadline for enrollment:

Trial enrollment closing date/date announcement will be removed from site:

Please provide a brief description in the space below. DBSA does not use medication names in trial descriptions. Please use general terms such as "antidepressant" or "mood stabilizer."

Site last updated: May 30, 2006

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Depression and Bipolar Support Alliance Clinical Trial Listing Form

Depression and Bipolar Support Alliance
Clinical Trial Listing Form