Vascular Surgery Clinical Research Participation Agreement

Study Information

Protocol Title: [Insert Study Name] Principal Investigator: [Name], MD Institution: [Institution Name] Study ID: [Number]

Purpose and Procedures

Study Overview

You are being invited to participate in a clinical research study involving vascular surgery. This document outlines your rights, responsibilities, and important information about the study.

Research Procedures

• Physical examination and medical history review
• Vascular imaging studies as applicable
• Blood samples collection (approximately [X] mL)
• Follow-up visits: [Specify frequency and duration]

Risks and Benefits

Potential Risks

• Standard surgical risks
• Imaging-related risks
• Privacy and confidentiality risks
• [List other study-specific risks]

Potential Benefits

• Access to novel treatments
• Contributing to medical knowledge
• [List other potential benefits]

Rights and Responsibilities

Participant Rights

1. Voluntary participation
2. Right to withdraw at any time
3. Access to study-related medical care
4. Confidentiality protection

Financial Considerations

• Study-related costs covered: [List items]
• Patient responsibility: [List items]
• Compensation details: [If applicable]

Authorization

I have read and understand the above information:

Participant Name (Print)

Participant Signature

Date

Investigator Signature

Date