The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

Neurodevelopmental Research Core (NDRC)- Inquiry Form

Returning?

A A A

The Neurodevelopmental Research Core (NDRC), located at Children’s Hospital Colorado, conducts a variety of developmental, behavioral and psychological assessments for pediatric clinical research protocols.

The NDRC also provides expert clinical research support during protocol development by advising on the selection and frequency of neurodevelopmental assessments.

IMPORTANT: THIS IS a RESEARCH program, NOT a clinical service. Please do not submit clinical information on this form.

Welcome to the NDRC's brief inquiry form.

Please fill out this quick form so that we can answer your questions about our services and fees.

We will respond within 5 business days. If you need to hear from us sooner, please note that in your answer to the last question.

Thank you!

Today's Date

M-D-Y

What information are you looking for about the NDRC?
**check all that apply

Available services

Cost estimate

Available tests

Advice regarding test selection

Other

What is your name?

PI's name

Study Name

Age range of participants

Tests to be given
**if known

Expand

Domains to be assessed
**if known

IQ/Intellectual Ability

Developmental

Academics

Language

Memory

Executive Function

Behavior

Adaptive

Sensory/Perceptual

Visuomotor/Visuospatial

Attention

Other

When do you anticipate submitting this grant to be reviewed for funding?
(i.e. Fall 2011, next month, in 2 years, etc.)

When do you anticipate submitting this study for COMIRB review?
(i.e. Fall 2011, next month, in 2 years, etc.)

Anticipated Funding Source Type
**check all that may apply

Government Funding

Industry or Private Funding

CTRC

Children's Hospital Colorado

University of Colorado, Denver

Other

Who should the NDRC contact to follow-up with the information requested?

Phone number of person to contact

How did you learn about the NDRC?
**check all that apply

NDRC Presentation

RI or NDRC Website

CCTSI Website

COMIRB Website

Referred by CTO

Referred by RI

Referred by CCTSI

Referred by COMIRB

Referred by CTRC

Referred by another investigator

Referred by Neurology Research (NART)

Other

Any additional information you would like to include?
Any specific questions that we can answer for you?

Expand

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.