Neuroimaging Study Consent Form

Study Title:

Principal Investigator:

Purpose of the Study

Study Procedures

Risks and Discomforts

Benefits

Confidentiality

Voluntary Participation and Withdrawal

Contact Information

Principal Investigator:
Email:
Phone:

Participant Statement

I have read and understood the information above. I have had the chance to ask questions and have had them answered to my satisfaction. I voluntarily agree to participate in this study.

Participant Name (print): Signature: Date:

Investigator Name (print): Signature: Date: