Clinical Stakeholder Intake Form

At Avasys, we believe the most impactful medical technologies begin with a deep understanding of real clinical challenges. We specialize in contract research and development for medical devices and drug delivery systems, starting with the voices of clinicians like you. By participating in interviews or research studies, you’ll help us uncover unmet clinical needs, improve user experience, and guide the development of innovations that are not only technically sound but truly meaningful in practice. If you’re open to sharing your insights, we’d love to connect.

Your Name *

First

Last

Email Address *

Phone Number

Current geographic area *

Please provide the name of the nearest major US city.

Primary Role *— Select Choice —Physician (MD/DO)Nurse Practitioner (NP)Physician Assistant (PA)Registered Nurse (RN)Pharmacist (PharmD)Clinical Pharmacist (PharmD, BCPS)Pharmacy TechnicianOther (Please specify in the comments section)

Degree(s) Obtained *

• MD
• DO
• PharmD
• DNP
• MSN
• BSN
• MPH
• MBA
• PhD
• Other (Please specify in the comments section)

Years of Clinical Experience *— Select Choice —Less than 1 year1-3 years4-7 years8-15 years16+ years

Practice Setting(s) *

• Academic Medical Center
• Community Hospital
• Outpatient Clinic
• Long-Term Care Facility
• Community Pharmacy
• Specialty Pharmacy
• Telehealth
• Research
• Other (Please specify in the comments section)

Primary Area(s) of Expertise *

• Cardiology
• Endocrinology/Diabetes
• Infectious Diseases/HIV
• Oncology
• Psychiatry/Mental Health
• Pain Management
• Pediatrics
• Geriatrics
• Critical Care
• Emergency Medicine
• Women’s Health
• Medication Therapy Management (MTM)
• Transitions of Care
• Pharmacogenomics
• Clinical Research
• Health Informatics
• Other (Please specify in the comments section)

Available for: *

• In-Person Studies in Baltimore, MD
• In-Person Studies in Washington, DC
• In-Person Studies in my geographic area (Please specify in the comments section)
• Remote/Online Studies

Comments

If you selected Other for any of the form fields above, please specify your entry here.

Degree(s) Experience Address

Consent *

• I agree to receive communication from Avasys, LLC

Your privacy is important to Avasys, LLC. We will use your personal information solely to manage your account and deliver the services or products you’ve requested. Occasionally, we may reach out with updates about our offerings or share content we think you may find valuable. You can opt out of these communications at any time. If you’re willing to hear from us for these purposes, please indicate by checking the box above. By clicking “Submit,” you agree to let Avasys, LLC store and use the information you’ve provided to fulfill your request.

Submit