CPET Informed Consent Form
Please complete this form to confirm your understanding and consent for the Cardiopulmonary Exercise Test (CPET).
Participant Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Contact Email
*
example@example.com
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Do you have any current health concerns or conditions that may affect your ability to safely participate in the test?
*
No
Yes (please specify below)
If yes, please specify your health concerns or conditions
I confirm that I have read and understood the purpose, procedures, and potential risks of the Cardiopulmonary Exercise Test (CPET).
*
Yes, I confirm
No, I do not confirm
Please share any questions or concerns you have about the CPET procedure.
Signature (Participant or Guardian)
*
Date of Consent
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Consent
Submit Consent
Should be Empty: