Investigator Initiated Study Request

To submit an Investigator Initiated Study (IIS) proposal for a study utilizing Mammotome 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 Mammotome.
If you have any questions regarding the form below, please feel free to contact Medical and Scientific Affairs.
Please complete the form in English. All fields are required unless otherwise indicated as “Optional”.

"*" indicates required fields

Principal Investigator and Contact Information

Principal Investigator (PI) Full Name*
Institution Address*

Study Details

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 Mammotome review board.

Statistical Methods (optional)

Budget (optional)

Milestones (optional)

Complete the anticipated dates for the following milestones of the proposed study
IRB Submission Target
Enrollment Start
Enrollment End
Final Data Analysis

Publication Strategy (optional)

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

Documentation (optional)

Please upload and confirm that the following documents are included with this proposal submission.
Drop files here or
Accepted file types: doc, docx, pdf, ppt, pptx, xls, xlsx, zip, Max. file size: 200 MB, Max. files: 4.
    Submission Type

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