Pharmaceutical Drug Trial Consent Form
Participant Information
Full Name
Date of Birth
Address
Phone
Email
Trial Information
Drug Name
Study Title/Protocol No.
Investigator Name
Study Location
Date
Purpose of the Study
Procedures
Risks and Discomforts
Potential Benefits
Confidentiality
Participation and Withdrawal
Contact Information
Consent
I have read and understood the above information. My questions have been answered to my satisfaction. I voluntarily consent to participate in this drug trial.
Participant Signature
Date
Investigator Signature
Date