Clinical trial: NCT06280781
Section: Participant's Rights
Subsections: Patient Signature

Your signature confirms that you have had an opportunity to ask questions and that all of your questions have been answered. [You will be given a signed and dated copy of this consent form]
Patient name (print):
Date signed:  
| Patient Signature: _______________________________   |
|------------------------------------------------------|  
________________________________  
________________  
Investigator Statement and Signature