Informed Consent

This consent form is made to inform you about the purpose of the study, possible risks and benefits and
your rights as a participants in the study. Every patient who is included in the study, their parents should
know that:

- Being in any research study is completely voluntary

- You may or may not benefit from being in study, but the knowledge we gain will be beneficial
for others.
- If you join the study you can quit any time. If you decide to quit the study I will not effect the
care of patient.
- You can ask any question or any information that you do not understand. You can ask now or
anytime in the study
- Please take time you need to talk to your doctor or family regarding being in this study
- If you decide to join please sign the consent form with date in the end

Patient name: ______________________________

Guardian name:_________________________________

Guardian relation with patient: __________________________

Date: ______________________________

Sign: __________________________________