Dental Research Study Participation Agreement

Study Information

Study Title: [Insert Study Title] Principal Investigator: [Insert Name] Institution: [Insert Institution Name] Study ID: [Insert Protocol Number]

Participant Information

Name: ________________________________ Date of Birth: _________________________ Contact Number: _______________________

Agreement Terms

1. Voluntary Participation

I understand that my participation in this dental research study is entirely voluntary. I may withdraw at any time without affecting my regular dental care.

2. Study Procedures

• I agree to participate in [specify procedures]
• Duration of participation: [specify timeframe]
• Number of required visits: [specify number]
• Required follow-up: [specify requirements]

3. Risks and Benefits

Potential Risks:

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

Potential Benefits:

• [List potential benefits]
• Contribution to dental research

4. Confidentiality

I understand that:

• My personal information will be kept confidential
• Data will be stored securely according to [specify regulations]
• Only authorized research personnel will have access to my information

5. Compensation

• [Specify compensation details if applicable]
• [Include information about covered costs]

Signatures

Participant Signature: _________________ Date: _______

Investigator Signature: ________________ Date: _______

Witness Signature: ____________________ Date: _______

Contact Information

For questions or concerns: Study Coordinator: [Insert Name] Phone: [Insert Phone] Email: [Insert Email]