Research Participation Consent Form - Colorectal Surgery Studies

Colorectal Surgery Clinical Studies

Study Information

Study Title: [Insert specific study title] Principal Investigator: [Name], MD Institution: [Institution name] Protocol Number: [Insert protocol number]

Purpose and Procedures

I understand that I am being asked to participate in a clinical research study involving colorectal surgery. The purpose of this study is to [insert specific purpose].

Study Procedures

• Initial consultation and screening
• Pre-operative assessments
• Surgical procedure documentation
• Post-operative follow-up visits
• Quality of life questionnaires

Risks and Benefits

Potential Risks

• Standard surgical risks
• Research-specific risks: [List specific risks]
• Possibility of confidentiality breach

Potential Benefits

• Contribution to medical knowledge
• Access to novel surgical techniques
• Enhanced follow-up care

Patient Rights

1. Voluntary participation
2. Right to withdraw at any time
3. Access to study results
4. Privacy protection

Authorization

Participant Name: _________________ Signature: _______________________ Date: ___________________________

Investigator Name: ________________ Signature: _______________________ Date: ___________________________

Contact Information

Study Coordinator: [Name] Phone: [Number] Email: [Email address]