Eli Lilly Samples Biorepository Request Form

Eli Lilly Sample Biorepository Request Form

Please note this form is for samples banked from the Eli Lilly Clinical Trial. If you are requesting any other samples a separate form must be completed.
Name of Requestor(Required)
Address(Required)
Describe the intended use/ proposed study for the samples.
Sample Type Requested(Required)
Check all that apply
Will you need access to the clinical data (if available)?(Required)
Provide a description of the samples you are requesting such as sample type, time points (single vs multiple), volume needed, and any clinical data requested (if available).
Describe the potential benefits to the patients who contributed these samples and/or the Duchenne community and related research field.
Are you willing to share your results?(Required)