Physical Therapy Research Study Participation Agreement

This agreement is made between [Research Institution Name] and the participant named below regarding participation in the physical therapy research study titled: [Study Title]

1. Participant Information

• Full Name: ________________________
• Date of Birth: ______________________
• Contact Number: ____________________
• Email: ____________________________

2. Study Details

• Principal Investigator: ______________
• Study Duration: ____________________
• Location: _________________________
• IRB Protocol Number: _______________

3. Participant Rights and Responsibilities

Rights:

• Voluntary participation with the right to withdraw at any time
• Access to all study-related information
• Confidentiality of personal and medical information
• Receipt of appropriate medical care for study-related injuries

Responsibilities:

• Attend scheduled sessions as agreed
• Follow prescribed exercise protocols
• Report any adverse events or concerns promptly
• Complete all required assessments and questionnaires

4. Risks and Benefits

Potential Risks:

• [List specific risks]
• [Include physical therapy-specific considerations]

Expected Benefits:

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

5. Compensation and Costs

• Compensation details: ________________
• Covered costs: ______________________
• Participant responsibilities: ____________

6. Authorization

I have read and understand the above information and agree to participate in this research study.

Participant Signature: _________________ Date: _________

Investigator Signature: ________________ Date: _________

Witness Signature: ___________________ Date: _________