Chiropractic Research Study Participation Agreement

Study Information

Study Title: [Insert Study Title] Principal Investigator: [Name], DC Institution: [Institution Name] Study ID: [Insert ID]

Participant Information

Name: ___________________________ Date of Birth: //________ Contact Number: _________________ Email: __________________________

Agreement Contents

1. Purpose of Research

I understand that I am being asked to participate in a research study investigating [brief description of research purpose].

2. Study Procedures

• Duration of participation: [specify timeframe]
• Number of visits required: [specify number]
• Types of treatments/assessments:
  • [List procedure 1]
  • [List procedure 2]
  • [List procedure 3]

3. Risks and Benefits

Potential Risks:

• [List potential risks]
• [Include common side effects]

Expected Benefits:

• [List potential benefits]
• [Include contribution to research]

4. Confidentiality

I understand that:

• My personal information will be kept confidential
• Data will be stored securely for [timeframe]
• Results may be published without identifying information

5. Voluntary Participation

• I can withdraw from the study at any time
• Withdrawal will not affect my regular care
• I will be informed of any new findings

6. Compensation

• [Detail any compensation]
• [Include insurance coverage information]

Signatures

Participant Signature: ___________________ Date: //____

Investigator Signature: __________________ Date: //____

Witness Signature: ______________________ Date: //____

Contact Information

For questions or concerns: Research Coordinator: [Name] Phone: [Number] Email: [Email]