Recruitment Request - DFMCH Research Services Hub

This Recruitment Request Form helps facilitate the review and approval process by clinic leadership for investigators wanting to recruit from clinics affiliated with the University of Minnesota Department of Family Medicine and Community Health’s (DFMCH) Primary Care Research Learning Network (PCRLN) ClinicMap.pdf. All projects must receive UMN IRB approval, including Fairview ancillary review as applicable in order to recruit from M Health Fairview clinics. Below are steps outlining the review and approval process:

Submit a Recruitment Request: Investigators interested in recruiting participants from PCRLN clinics must submit a Recruitment Request form. Please ensure that all sections of the form are fully completed to help us assess your needs and current stage in the research process. Completing the request form will take about 10 minutes.
Communication Regarding the Recruitment Request: Once submitted through the portal, your request will be routed to the PCRLN for review. A team member may contact you via email to request additional information about your request.
Clinic Review Process: After the request is reviewed, Research Facilitators at designated clinics will discuss the recruitment request with their clinic’s research review committee team to assess feasibility and interest. A team member may contact you with questions in response to your recruitment request during this process.
Clinic Decision: Decisions regarding the recruitment request will be communicated with you via email and/or Zoom meeting as they are made. Please note that each clinic has a unique review process and recruitment requests review may take up to 4-6 weeks.

For assistance with your recruitment request or more information about the PCRLN, please reach out to pcrln@umn.edu.
If you are also interested in recruiting patients from M Health Fairview clinics, including Bethesda, Smiley’s and Phalen Village, through phone calls, MyChart, and/or mailing letters via USPS, please review Fairview Research Recruitment Services website and complete their Fairview Research Intake Form. Please note there are fees for these services.

Name*

Email*

Phone Number*

Project Title*

Organization*

Project PI*

Description of Project
If this project is a clinical trial please provide the clinicaltrials.gov link below.

What Clinic(s) you would like help from?

Please explain*

How many patients do you hope to recruit from these clinics?

Inclusion/Exclusion criteria

What will patients be asked to do?

Other Description

Will participants be asked to attend in-person visits

Please specify

What are you asking the clinic physicians/staff to do?

Please describe what you are asking the clinic physicians/staff to do.

Please describe how the staff will help implement the study plan

How will this project benefit our patients or clinic?

Anticipated Start Date

Anticipated End Date

What stage is your project's IRB protocol?*

Please explain*

Is there financial support?

Would you like to meet with the clinic research committee?

Would you be interested in future collaborations with Family Medicine?

Is there opportunity for faculty and/or residents to be involved in scholarship resulting from this project/study?

Will transportation costs be covered or arranged for participants?

Will there be incentives for participants?

Please describe

Are non-English speakers eligible to participate?

Languages

Please specify

Will interpreters be available?

Upload Supporting Documents

Please upload any fliers or marketing materials for your project.
If this project involves informed consent, please upload the form participants will complete.

Uploaded Supporting Documents

Recruitment Request Form Submission Overview

Contact Information

Recruitment Information

Recruitment Details

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