Labrynth Pharmaceutical
CONSENT TO PARTICIPATE IN A RESEARCH STUDY
Sponsor: Labrynth Pharmaceutical
Principal Investigator: Charles Prager, M.D.
Reviewing Board: Meridian Institutional Review Board
WHAT IS THE PURPOSE OF THIS FORM?

You are being asked to take part in a research study. You do not have to take part. You should only agree to participate after reading this consent form and discussing it with the study team. You may also discuss this with your family, friends, health care providers or others before you make a decision.

ABOUT THIS STUDY

The purpose of this study is to assess whether an investigational drug (to be named, herein referred to by its chemical compound identifier LP-265) can be affective in a wide patient population.

WHY WOULD YOU WANT TO TAKE PART IN THIS STUDY?

By participating you may help to understand the mechanism of LP-265. In this study, by chance (like flipping a coin) half of subjects will be assigned to receive LP-265 and the other half will receive placebo. Even if you do not receive LP-265, the information gained by participating in this study may help others in the future.

TERMS AND CONFIDENTIALITY

Your individual health records are your own, but all information relating to LP-265, its mechanism, its utility, all study results and any correspondence you have with the study team during this trial are the property of Labrynth Pharmaceutical. We expect your discretion when speaking with anyone about your experience during this trial.

Your identity and any records connected to your participation will be held in strict confidence by the Sponsor and the Principal Investigator.

CONSENT

By signing below, you confirm that you have read this form and voluntarily agree to proceed.

Date:
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