The study start-up phase in any clinical trial is crucial and time demanding. A key challenge in conducting the clinical trials is that it spans across so many different parties, including study sponsors, contract research organizations (CROs), site management organizations (SMOs), investigators, study teams and patients. This is all the more at the start-up phase, where the project team is also in its forming stage. Timely completion of study start up activities such as collection of essential documents, translations, submission to ethics review committees and regulatory authority ensures a quick trial initiation. RemediumOne has an excellent track record in initiating a number of studies successfully in the country. With a team dedicated solely to handle start up activities, RemediumOne has been successful in initiating sites within 6 months of awarding the study to Sri Lanka.