Joint Department of Medical Imaging (JDMI) Research Office

Project Request Form

Please do not share any Personal Health Information about human study participants and/or patients.

Introduction

This form is to request an initial or preliminary review by JDMI research for proposed projects.
Name*
First Last
Email*
Phone*
Project Name*
Project Description*
Project Lead / Principal Investigator (if applicable)*
Department / Division
Site / Organization*
Services Requested*
Please describe
Is this a research project involving humans?*
- Yes
- No
Has REB approval been obtained?
- Yes
- No
What is the REB Number
Is this a multi-site project?*
This will have data sharing and security/privacy considerations)
- Yes
- No
Estimated Budget*
Target Start Date*
MM slash DD slash YYYY
Target Completion Date*
MM slash DD slash YYYY
Phone
This field is for validation purposes and should be left unchanged.

Contact

700 University Avenue – 2nd Floor North
Toronto, ON
M5G 1X6
Email: jdmiresearch@uhn.ca

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Joint Department of Medical Imaging (JDMI) Research Office

Project Request Form

Introduction