Free Clinical Trial Leaflet Request Form
Number of Leaflet Request:
*Please input Number of Leaflet Request
*Please input an integer
First Name:
*Please input FirstName
Last Name:
*Please input Surname
Delivery Address:
*Please input Delivery Address
School / Department:
Accident and Emergency
Anaesthesia and Intensive Care
Anatomical and Cellular Pathology
Biomedical Sciences
Chemical Pathology
Chinese Medicine
Clinical Oncology
Imaging and Interventional Radiology
Medicine and Therapeutics
Microbiology
The Nethersole School of Nursing
Obstetrics and Gynaecology
Ophthalmology and Visual Sciences
Orthopaedics and Traumatology
Otorhinolaryngology, Head and Neck Surgery
Paediatrics
Pharmacy
Psychiatry
The Jockey Club School of Public Health and Primary Care
Surgery
Others: Please specify
*Please input School / Department
Institution:
CUHK
PWH
AHNH
TPH
BBH
SCH
NDH
SH
*Please input Institution
Contact Tel No.(8 digits):
*Please input ContactPhone
*Contact Tel No. must be 8 digits
Email:
*Please input Email
*The Email is invalid!
*Must be either CUHK or HA email address
For enquiry, please contact 3505-4276 or
crmo@cuhk.edu.hk
: