GBS Expedite Clinical Trial Logistics
LKF Global Trials
Protocol BAY 22158
Request For Pick-Up
Request For Pick-up Of Specimens By Special Courier Service
Please submit this form three working days before the day of pick-up
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Trial center number
*
Choose Your Trial Center ID From The List
14002 - Beth Israel Deaconness Med.Ctr. BIDMC - Gryzmish 522, 330 Brookline Ave, Boston, MA 02115
14003 - US Health Dermatology - Suite 5300, 222 Piedmont Ave, Cincinnati, OH 45219
14004 - Arlington Research Center, Inc. - Suite 200, 711 East Lamar Blvd, Arlington, TX 76011
14005 - NorthShore University Health System - Clinical Trials Center Suite 100, 9933 Woods Drive, Skokie, IL 60077
Contact person at trial center
*
Email
*
Phone
*
Please enter the day+date of pick-up and the time frame preferred by trial center
*
A time frame of at least two hours is required (e.g. between 2 and 4 PM). We would appreciate your submitting this form three working days before the pick-up day.
Please tick the type of samples you will be shipping
*
Frozen Specimens
Ambient Specimens
If you ticked frozen specimens, please confirm if you will need us to bring dry ice
Yes, please bring the dry ice
No, we provide our own dry ice
Please confirm packaging inventory needs
*
We do not hold the shipping boxes at our facility. Please bring the shipping boxes
No need to bring the shipping boxes since we already hold them at our facility
If you ticked that we need to bring the shipping boxes, please specify the number of BIO15 shipping boxes required
For frozen samples we provide 10kg of dry ice and we use a BIO15 box (10x10x10 inches inside). Please specify if you will need more than one BIO15 box
If you ticked that we need to bring the shipping boxes, please specify the number of BIO10 shipping boxes required
For ambient samples we use a BIO10 box (10x8x7 inches inside). Please specify if you will need more than one BIO10 box
Comment or Message
If you have any questions regarding how to complete this form please send an email to
[email protected]
or call 1631-446-8024 ext 2
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