PResNet Research Request Form

PResNet is a source of advice and guidance for pediatric health care providers who would like to conduct a research project. This worksheet is a guide for clinicians who would like to develop a practice-based research idea with the Network's assistance. Please respond to all of the questions below and send via fax (317) 278-0456 or email to Cathy Luthman, Executive Director of PResNet, at

Click here for the PDF file: PResNet_Research_Req_Form_pdf.pdf

Note: This is an editable PDF, but if you are not able to save it to your computer (which requires the professional version of Adobe Acrobat) then you will still need to print and fax the form after filling it out. You may also download the Word file Research_Idea_Form.doc (20 KB), save and then email it to us.