In general, the affidavit form will need to be filled out by the person responsible for conducting the experiment.
Please provide your full name and contact information:
Have you ever been a patient in a hospital or other medical facility?
Have you ever been a subject in a research study?
Have you ever been a surgical patient?
Are you currently taking any medications?
Do you have any medical conditions?
Are you pregnant or breastfeeding?
Do you have any allergies?
Do you have any religious or cultural beliefs that might affect your participation in a surgical experiment?
Would you be willing to sign a consent form allowing your participation in a surgical experiment?