RESEARCH PATEINT CONSENT FORM

  • Date Format: MM slash DD slash YYYY
    As a research patient, I agree to share my case details for training and research purposes. I understand my personal details are kept private.
    As a research patient, I agree to follow dietary recommendations and undergo in-clinic treatments as prescribed by my practitioner.
    As a research patient, I agree to complete any forms, evaluations, and research surveys as requested.
    As a research patient, I understand I will not be charged for my treatment. I also understand that I will be assisting the clinic in developing advanced protocols for difficult cases and there are no guarantees for successful treatment outcomes.