Multi-site International Study
Informed Consent Waiver Form

Study Title:

Principal Investigator Name and Contact Information:

Study Site(s):

Purpose of the Study

Procedures

Potential Risks and Discomforts

Potential Benefits

Confidentiality

Voluntary Participation

Waiver of Informed Consent

The study has been approved for a waiver of signed informed consent by the responsible ethics review board. Participation is voluntary and you may withdraw at any time without penalty or loss of benefits.

Contacts for Questions or Concerns