TEST Data Use Form

This form is used to request permission for data use from PCG studies.
  • Note: Teleconferences to discuss your request with PCG staff are welcome and encouraged.
  • Requester information

  • Though more than one person may be involved with a project, only one person is permitted on the request. The investigators are responsible for abiding by PCG policies for this request.
  • Project Information

  • PCG Electronic Database

  • Please note that for DICOM-RT files, the data that is included is from July 2017 to current. Requests for DICOM-RT data prior to this date will be considered a special project with a timeline of a minimum of 90 days. PCG is not able to guarantee all files can be obtained from the institutions.
  • If medical records may be needed for your project, please contact PCG directly at [email protected] or call the office at (630) 836-8668. Further information will be provided.
  • Goal of the project

  • Conferences/Locations
  • The year the abstract will be presented
  • Signature

  • This field is for validation purposes and should be left unchanged.