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Consent Form
I have read the consent form and recognize that my participation in this study is entirely voluntary and that I am free to withdraw at any time during the course of the study without consequence. I understand that any information resulting from this study will be strictly confidential. I realize that I may ask for further information about this study if I wish to do so at any time. I have received a copy of this consent form for my own records. I agree to participate in this study.

_____________________________ Subject Signature

_____________________________ Date

_____________________________ Print Name of the Subject

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