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TITLEHERE
TOPICHEREREASONHERE
We ask that you read this document and ask any questions you may have before agreeing to be in the study.
AFFILIATIONHERE
Background Information:
PURPOSEHERE
Procedure:
PROCEDUREHERE
Risks and Benefits of Being in the Study:
The study has the following risks: RISKSHEREBENEFITSHERE
COMPHERE
Confidentiality:
CONFHERE
Voluntary Nature of the Study
COOPHERE
New Information
NEWINFOHERE
Contacts and Questions
RNAMEHEREYou may ask any questions you have now.
RADDRESSHERE
ROTHERHERE
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 Participant ________________________ Date ___________
THIS PROJECT HAS BEEN REVIEWED BY THE CALIFORNIA STATE UNIVERSITY, LOS ANGELES INSTITUTIONAL REVIEW BOARD FOR THE PROTECTION OF HUMAN SUBJECTS IN RESEARCH (Phone number: 323-343-5366)


