Investigator Initiated Study Request

To submit an Investigator Initiated Study (IIS) proposal for a study utilizing Leica Biosystems products, please complete the form below. Completion and submission of this form will help facilitate a process to review and assess the study for potential support by Leica Biosystems.

If you have any questions regarding the form below, please feel free to contact Medical and Scientific Affairs at medicalaffairs@leicabiosystems.com.

Fill out Form Below

Please complete the form in English. All fields are required unless otherwise indicated as "Optional".

Principal Investigator (PI) Full Name

PI Email

PI Phone

PI Institution

Institution Phone

Institution Address

City

State/Province (Optional)

ZIP/Postal Code

Country

Title of Proposed Study

Investigational Product or Device

Background & Rationale for Study

Hypothesis

Primary Endpoint

Overview of Study Design

Study Objectives

Comparator Products to be Used (as applicable)

Site Names

Please complete details below if known. You may submit this form without completing the below for an initial concept review, but note that all fields much be completed for formal Leica Biosystems review board.

Statistical Methodology

Sample Size

Subject Type and Number

Total Study Budget

Currency

Please Confirm Currency

Complete the anticipated dates for the following milestones of the proposed study

IRB Submission Target

Enrollment Start

Enrollment End

Final Data Analysis

Please provide details on the proposed publication strategy (i.e. journal in which to publish, abstract presentation at a congress, etc.)

Please upload and confirm that the following documents are included with this proposal submission.

Select file(s)

Maximum 4 files.
200 MB limit.
Allowed types: doc, docx, pdf, ppt, pptx, xls, xlsx, zip.

PI Curriculum Vitae

Curriculum Vitae for PI at each Study Site

Itemized Budget Proposal

Evidence of appropriate approval from institution for use of human tissue (as applicable)

I authorize Leica Biosystems to contact me for the purposes selected. I understand that I may be contacted by a phone call, text message and/or email.

By clicking the Submit button and proceeding I confirm that I have reviewed and agree with the Terms of Use and the Leica Biosystems Privacy Policy. I also understand my privacy choices as they pertain to my personal data as provided in the Leica Biosystems Privacy Policy.

Investigator Initiated Study Request

Principal Investigator and Contact Information

Study Details

Statistical Methods (optional)

Budget (optional)

Milestones (optional)

Publication Strategy (optional)

Documentation (optional)