Speech Therapy Research Study Participation Agreement

Purpose of Research

I, [Participant Name], hereby agree to participate in the speech therapy research study titled [Study Title], conducted by [Institution/Practice Name].

Study Details

Duration and Commitment

• Study period: [Start Date] to [End Date]
• Number of sessions: [X] sessions
• Session duration: [X] minutes per session
• Location: [Facility Address]

Procedures

The study will involve:

1. Initial assessment of speech and language abilities
2. Regular therapy sessions using [specific intervention method]
3. Progress monitoring and data collection
4. Follow-up evaluations

Rights and Responsibilities

Participant Rights

• Right to withdraw at any time without penalty
• Access to personal data collected during the study
• Confidentiality of all personal information
• Receipt of study results upon completion

Research Team Responsibilities

• Maintain professional standards of care
• Protect participant privacy
• Provide clear communication about procedures
• Address concerns promptly

Risks and Benefits

Potential Risks

• [List specific risks]
• Minimal discomfort during assessments
• Time commitment

Expected Benefits

• [List potential benefits]
• Contribution to speech therapy research
• Possible improvement in communication skills

Consent and Authorization

I understand that:

• My participation is voluntary
• My personal information will be protected
• I can request study results
• I have received a copy of this agreement

Participant Signature / Date

Researcher Signature / Date

Witness Signature / Date