Dear Healthcare Provider,
Thank you for your interest in studying Gleolan at your institution. In order to begin our review process, please complete and submit this form to Kelli Hill, NXDC IIT Coordinator at email@example.com. Once we receive your study information, our IIT Review Committee will evaluate and provide feedback to the contact person listed on this form. Feedback can be expected 2-4 weeks after receipt of this form.
V 1.0 April 2020