Informed Consent Form
Emergency Medicine Research Study
Project Title
Principal Investigator
Institution
Information About the Study
Purpose of the Study:
Procedures:
Duration:
Risks and Discomforts:
Benefits:
Confidentiality:
Compensation:
Voluntary Participation
Contact Information
Questions about the study:
Consent
I have read and understood the information provided above. I have had the opportunity to ask questions. I voluntarily agree to participate in this study.
Participant Name:
Participant Signature:
Date:
Person Obtaining Consent (Name):
Signature:
Date: