Reimbursement of expenses request

Are you a patient, an ambulance or taxi company, a clinical research technician or an investigator?

Would you like to file a fee refund form and proof for the very first time?

Submit your application below. The average processing time is 30 to 45 days. We must obtain the principal’s validation before making the payment.

Claims are only possible through another form.

You can contact us on +33(0)9 72 57 48 30 from 9am to 12pm Monday to Friday (CET). We are based in France.

Your name

Your surname

your email

your phone number (please add the indicatif)

Your company (Not mandatory)

Clinical study name (Mandatory)

Patient's number in the clinical study (Mandatory)

Site number (Mandatory)

Your message

download your reimbursement form with justification documents
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I read and accepted the confidentiality policy of this site

Pharmaspecific has IT resources to manage the costs incurred by participants. The recorded information is reserved for the use of the relevant service and can be shared with data hosting companies. Some of these recipients are located outside the European Union.
These recipients will have your names, first names, bank details, fees incurred. Accommodation takes place in suitable countries, or in countries where the transfer is framed by standard contractual clauses to ensure a sufficient level of protection of personal data. You have the right to access and correct information about you.
In accordance with the amended “Computer and Freedoms” Act of January 6, 1978 and to RGPD, you have the right to access and correct information about you.
You can access information about yourself by contacting: Pharmaspecific, Parc Descartes Nobel, 23 rue Nobel 77420 Champs-sur-Marne.