We ask that you read this document and ask any questions you may have before agreeing to be in the study.
Risks and Benefits of Being in the Study:The study has the following risks: RISKSHERE
Voluntary Nature of the StudyCOOPHERE
Contacts and QuestionsRNAMEHERE
You may ask any questions you have now.
You will be given a copy of this form to keep for your records.
Statement of Consent:I have read the above information. I have asked questions and have received answers. I consent to participate in the study.
SIGHERE PROXYHERE PARENTHERE Signature of Investigator or Person Obtaining Consent ________________________ Date ___________