Population Health and Cancer Outcomes Core (PHCOC) Service Request Form

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Please complete this form to request Core services. Initial consultations for each new project are free of charge – please indicate the services you would like to discuss for your project. A Core member will contact you within two business days to discuss your project, a free consult (if needed), and any related charges. By receiving PHCOC support or services, you agree to acknowledge the Core in all publications or presentations. Please direct questions to Dr. Raj Balkrishnan: rb9ap@virginia.edu


How will you be making payment for Core services? (Billing will not occur until after initial discussion and/or complimentary consultation.)
Has this project received IRB approval?
Services Requested
Indicate which services you are in need of:
Data Services (Provided by Raj Desai)
Study Design and Measure Development (Provided by Dr. Rajesh Balkrishnan and Dr. George Batten)