Research Consent Form - Department of Veterans Affairs
RESEARCH CONSENT FORM
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SUBJECT NAME
DATE (MM/DD/YYYY)
TITLE OF STUDY
PRINCIPLE
INVESTIGATOR
VAMC
DESCRIPTION OF RESEARCH BY INVESTIGATOR 1.Purpose of study and how long it will last: 2. Description of
study including procedures to be use:; 3. description of procedures that may result in disconfort or inconvenience:
4. Expected risks of study: 5. Expected benefits of study: 6. Other treatment available: 7. Use of research results:
8. Special circumstances.
SUBJECT'S IDENTIFICATION
VA FORM
MAR 2006
10-1086
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