Dermatological Research Study Participation Agreement

Study Information

Study Title: [INSERT STUDY TITLE] Principal Investigator: [INSERT NAME] Study ID: [INSERT NUMBER]

Participant Information

Name: _______________________ Date of Birth: _______________ Contact Number: _____________

Agreement Contents

1. Purpose of Research

I understand that I am being asked to participate in a dermatological research study investigating [INSERT SPECIFIC FOCUS]. The purpose of this research is to [INSERT PURPOSE].

2. Study Procedures

• Duration of participation: [INSERT TIME PERIOD]
• Number of visits required: [INSERT NUMBER]
• Procedures to be performed: [LIST PROCEDURES]
• Required skin examinations and/or biopsies: [SPECIFY DETAILS]

3. Risks and Benefits

Potential Risks:

• [LIST POTENTIAL RISKS]
• Possible skin reactions or irritation
• Temporary discomfort during procedures

Potential Benefits:

• [LIST POTENTIAL BENEFITS]
• Access to experimental treatments
• Contributing to dermatological research

4. Confidentiality

All personal and medical information will be kept strictly confidential in accordance with [INSERT RELEVANT PRIVACY LAWS].

5. Compensation

• Compensation amount: [INSERT AMOUNT]
• Payment schedule: [INSERT SCHEDULE]
• Reimbursement for travel: [INSERT DETAILS]

6. Voluntary Participation

I understand that my participation is entirely voluntary and I may withdraw at any time without penalty.

Signatures

Participant Signature: _________________ Date: _______

Investigator Signature: ________________ Date: _______

Witness Signature: ___________________ Date: _______