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Clinical Epidemiology and Biostatistics Unit _CEBU_

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					                        Clinical Epidemiology and Biostatistics Unit (CEBU)
                                                           Initial Meeting Form
In order to help you as much as possible, before an initial meeting we need to know some brief details of your
enquiry and how you would like us to help you. Please return the completed form to CEBU or bring it with you to
your initial consultation (contact details at foot of page).

Please note: For student consultations, supervisors are required to attend the initial consultation.


Appointment Date:                                                                      Appointment time:

Name/s:                                                                               Supervisor’s name:

Department/Research Group:

Position:

Contact details:                            Ph:                                  Email:

Reason for consultation:




Affiliation (mark all that apply):                RCH
                                                  MCRI – Specify Research Theme
                                                  Melbourne University
                                                  Other – Specify Organisation

If the consultation is related to a research project please complete the following information:

Title of project:

Type of project:                                  PhD Student
                                                  M Med Student
                                                  MD
                                                  Master of Nursing
                                                  AMS
                                                  Other – specify
                                                  FRACP
                                                  Other College
                                                  Other - specify

State of project:                                 Planning/thinking about it
                                                  Ethics application
                                                  Collecting data
                                                  Analysis/writing up


Brief outline of Project:




Signature                                                                                       Date
                (should be a supervisor or senior investigator where applicable)

Clinical Epidemiology and Biostatistics Unit, Royal Childrens Hospital, Parkville, Victoria 3052, AUSTRALIA. PHONE (03) 9345-6363/6368 FAX (03) 9345-6000
email: donna.desair@mcri.edu.au

				
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