Investigator Initiated Research Application

Investigator Initiated Research Application

Thank you for considering Pure Encapsulations® for your research needs. We are proud to support nutritional research at leading institutions around the world. While we aim to support as many studies as possible, regretfully, we cannot accommodate all applicants. In order for us to properly evaluate your request, please complete the following application.
Today's Date *

Month Day Year
Date

CV and Proposal
Please attached the curriculum vitae of the Principal Investigator along with any pertinent illustrations or descriptions of the study design. *

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Study Description
Study title *
Tentative study title.
Research objective *
Briefly summarize the objective of this research.
Study design *
Describe the treatment arms and anticipated number of participants.

Packaging
Do you intend to rebottle or repackage the requested product(s)? *

Yes No
How would you prefer the product(s) be delivered? *

In polyethylene bags In bottles
Allow Pure Encapsulations to decide the number of capsules per bottle/bag? *

Yes No

Product Request

Please anticipate a lead time of at least 12 weeks for product requests. Do not enter placebo information on this page.
Product #1
Please describe the ingredient(s) and dosage(s) in Product #1.
Number of capsules per bottle/bag
Enter N/A if Pure Encapsulations is to decide.
Number of bottles/bags
Enter N/A if Pure Encapsulations is to decide.
Total number of capsules
Additional notes
Add a second product? *

Yes No
Product #2
Please describe the ingredient(s) and dosage(s) in Product #2.
Number of capsules per bottle/bag
Enter N/A if Pure Encapsulations is to decide.
Number of bottles/bags
Enter N/A if Pure Encapsulations is to decide.
Total number of capsules
Additional notes
Add a third product?

Yes No
Product #3
Please describe the ingredient(s) and dosage(s) in Product #3.
Number of capsules per bottle/bag
Enter N/A if Pure Encapsulations is to decide.
Number of bottles/bags
Enter N/A if Pure Encapsulations is to decide.
Total number of capsules
Additional notes
Add a fourth product?

Yes No
Product #4
Please describe the ingredient(s) and dosage(s) in Product #4.
Number of capsules per bottle/bag
Enter N/A if Pure Encapsulations is to decide.
Number of bottles/bags
Enter N/A if Pure Encapsulations is to decide.
Total number of capsules
Additional notes
Describe any additional product requests here:
Please include ingredient and dosage(s)

Placebo Request
Are you requesting a placebo?

Yes No
Number of placebo capsules requested
Pure Encapsulations Default Placebo Protocol: If the active ingredient is white, the placebo will made using cellulose (an inert, white powder) and a clear capsule. If the active ingredient is not white, the placebo will be made using cellulose and an opaque purple capsule.

I accept Pure Encapsulations default placebo procedure. I would like to discuss other options.
Please describe how you would like the placebo to be color-matched.

Custom Label
Will you need a custom label?

Yes No
Please note: the research group is responsible for creating the custom label. Labels may be provided after the study is accepted.

I acknowledge that I am responsible for labeling the study product in accordance with local laws and will provide Pure Encapsulations with the necessary information to label the product appropriately. I would like to discuss other options.
Please describe your concerns:

Testing

Pure Encapsulations’ manufacturing facility is FDA inspected and NSF-GMP registered. Each batch of raw material is tested upon reception for identity, potency and contaminants, including (when applicable) microbial contaminants, heavy metals, an extensive panel of residual solvents and pesticides, aflatoxins, allergens, melamine, oxidation, PCB’s and PCB-like compounds, dioxins, furans and others. By default, Pure Encapsulations will test the final product (active) for potency and microbial contamination and the final product (placebo) for active ingredient and microbial contamination.
Please specify any additional testing requirements or write N/A: *

Preferred Delivery Date

Pure Encapsulations is an industry-leading manufacturer of professional-grade supplements with a growing demand around the world. Please anticipate a 12 week lead time for products and a 16 week lead time for custom formulations and placebos.
Preferred delivery date *

Month Day Year
Date

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Application Overview