theuniversityoftexassouthwesternmedicalcenter.docVIP

The University of Texas Southwestern Medical Center Parkland Health Hospital System Children’s Medical Center Retina Foundation of the Southwest Texas Scottish Rite Hospital for Children Texas Health Presbyterian Hospital Dallas CONSENT TO PARTICIPATE IN RESEARCH Title of Research: [insert title] Funding Agency/Sponsor: [if no external funds, state UT Southwestern Medical Center] Please insert the names of the investigators and those individuals who will obtain consent. Study Doctors: [insert investigators names] Research Personnel: [insert research personnel names] You may call these study doctors or research personnel during regular office hours at [insert phone number]. At other times, you may call them at [insert after hours phone number]. Instructions: Please read this consent form carefully and take your time making a decision about whether to participate. As the researchers discuss this consent form with you, please ask him/her to explain any words or information that you do not clearly understand. The purpose of the study, risks, inconveniences, discomforts, and other important information about the study are listed below. If you decide to participate, you will be given a copy of this form to keep. Note: If you are a parent or guardian of a minor and have been asked to read and sign this form, the “you” in this document refers to the minor. What you should know about this study: You are being asked to join a research study. This consent form explains the research study and your part in the study. Please read it carefully and take as much time as you need. Please ask questions at any time about anything you do not understand You are a volunteer. If you join the study, you can change your mind later. You can decide not to take part or you can quit at any time. There will be no penalty or loss of benefits if you decide to quit the study. If you are not scheduled to undergo a procedure for clinical reasons, you must be an adu