Occupational Therapy Research Study Participation Agreement

Study Information

Study Title: [Insert Study Title] Principal Investigator: [Name], [Credentials] Institution: [Institution Name] Contact Information: [Phone] | [Email]

Participant Information

Name: _________________________________ Date of Birth: __________________________ Contact Number: ________________________ Email: _________________________________

Purpose of Research

I understand that I am being invited to participate in a research study investigating [brief description of research purpose]. This study aims to [insert specific aims].

Study Procedures

1. Duration of Participation

   • Total length of study: [specify timeframe]
   • Number of sessions: [specify number]
   • Length of each session: [specify duration]

2. Required Activities

   • [List specific activities]
   • [Include assessments]
   • [Detail interventions]

Risks and Benefits

Potential Risks

• [List potential risks]
• [Include mitigation strategies]

Expected Benefits

• [List potential benefits]
• [Include societal benefits]

Rights and Confidentiality

• Participation is voluntary
• Right to withdraw at any time
• Data protection measures
• Privacy safeguards

Consent Declaration

I, the undersigned, confirm that:

• I have read and understood this agreement
• My questions have been answered satisfactorily
• I agree to participate in this research study

Participant Signature: ___________________ Date: ________

Investigator Signature: __________________ Date: ________

Contact Information

For questions or concerns:

• Research Team: [contact details]
• Ethics Committee: [contact details]