CoreRx™ Pharmaceuticals
 
Please help us to better serve your needs by completing this brief questionnaire regarding your proposed project.
Contacted By/Heard About Us From:
Name:
Title:
Company:
Address 1:
Address 2:
City:
State:
Zip Code:
Phone:
Email:
Short Project Description:
Project Time Frame:

Special Handling Required:
Controlled Substance; Class 
Potent Compound; Class
Light/Heat Sensitive
Other
If Other:

Pre-formulation
Describe Required Testing:

Analytical
Brief Description of Testing:
Will test methods be provided?
 Yes   No
Drug Substance: Assay
Related Substances
Drug Product: Assay
Related Substances
Dissolution
Test Methods Required
Assay
Related Substances
Dissolution
Other
If other:
ID; by
If other:
Method Validation Required
Assay
Related Substances

Dissolution
Other
If other:

Formulation Development
Brief Description of Needs:
Phase of Project:
Tox
Phase I
Phase II
Phase III
Other
If other:
Excipient Compatibility:
How many excipients?
Prototype Stability:
Storage Temperature:
5°C
25°C
30°C
40°C
other °C
Storage Humidity:
60%RH
65%RH
70%RH
75%RH
other %RH

Manufacturing Services
Brief Description of Needs:
cGMP      non-cGMP
Dosage Form Desired:
Parenteral:
Liquid
Lyophilized
Suspension


Oral:
Oral Liquid

Semi-Solids:
Cream
Gel
Ointment


Other:
If other:
Solids:
Tablet
Capsule
Liquid Capsule
Lozenge
API in capsule
Overencapsulation
Suppository
Dosage Strength(s) Desired:
Approximate Batch Size:

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