Psychiatric Research Study Participation Agreement

Study Information

Study Title: [INSERT STUDY TITLE] Principal Investigator: [INSERT NAME], MD Institution: [INSERT INSTITUTION] IRB Protocol Number: [INSERT NUMBER]

Participant Information

Name: ________________________ Date of Birth: _________________ Study ID: _____________________

Agreement Terms

1. Voluntary Participation

I understand that my participation in this psychiatric research study is entirely voluntary. I may withdraw at any time without affecting my current or future medical care.

2. Study Procedures

• Duration of participation: [INSERT DURATION]
• Number of visits required: [INSERT NUMBER]
• Procedures to be performed: [LIST PROCEDURES]
• Medications involved (if any): [LIST MEDICATIONS]

3. Risks and Benefits

Potential Risks:

• [LIST POTENTIAL RISKS]
• [INCLUDE PSYCHOLOGICAL RISKS]
• [INCLUDE PRIVACY RISKS]

Potential Benefits:

• [LIST POTENTIAL BENEFITS]
• Contribution to medical knowledge

4. Confidentiality

All personal and medical information will be kept strictly confidential in accordance with HIPAA regulations. Data will be stored securely and accessed only by authorized research personnel.

5. Compensation

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

6. Emergency Contacts

Principal Investigator: [PHONE] Research Coordinator: [PHONE] Emergency Contact: [PHONE]

Signatures

Participant Signature: _________________ Date: _________

Investigator Signature: ________________ Date: _________

Witness Signature: ___________________ Date: _________

IRB Contact Information

[INSERT IRB CONTACT DETAILS]