Informed Consent for Clinical Research Participation

Title of Study:

Principal Investigator:

Institution:

Contact Information:

Introduction

Purpose of the Study

Procedures

Potential Risks and Discomforts

Potential Benefits

Confidentiality

Voluntary Participation and Withdrawal

Compensation

Contact for Questions

Statement of Consent

I have read and understood the information above. I have had the opportunity to ask questions, and all of my questions have been answered to my satisfaction. I freely consent to participate in this research study.