Clinical Trial Payment Agreement Form

The Clinical Trial Payment Agreement Form is a financial document that establishes the complete payment framework between a research site and a study participant. Clinical trials often involve participant compensation for time and inconvenience, travel reimbursement, and a complex division of medical costs between the research sponsor, insurance payers, and the participant. This agreement consolidates all financial terms into a single, transparent document so that participants understand exactly what they will receive, what they may owe, and how billing will be handled throughout the duration of the study. It serves as both a financial disclosure and a binding acknowledgment of payment terms.

The form captures specific financial details across several categories. Participant compensation fields document the payment amount per study visit, the total potential compensation for completing all protocol requirements, and the payment schedule including method of disbursement (check, direct deposit, or prepaid card). Travel reimbursement sections record mileage rates, parking allowances, and lodging policies for multi-day protocols. The agreement lists sponsor-covered research procedures separately from standard-of-care services that will be billed to the participant's insurance, with estimated co-pay and deductible amounts for insurance-billed items. It also addresses financial responsibility for research-related injuries, tax reporting requirements for compensation exceeding IRS thresholds, and the process for handling payments if a participant withdraws early from the study.

This form is used across academic medical centers, contract research organizations (CROs), pharmaceutical sponsor sites, hospital research departments, and facilities conducting Phase I through Phase IV clinical trials. It satisfies Good Clinical Practice (GCP) guidelines that require transparent financial disclosure as part of the informed consent process. Institutional review boards (IRBs) review participant compensation structures to ensure payments are not coercive, and this agreement provides the documentation needed for that evaluation. By clearly defining all financial terms upfront, the form reduces disputes, supports participant retention, and protects institutions from liability related to billing errors or undisclosed costs that could undermine trust in the research program.

Getting started with this template takes just a few minutes. Sign up for a free Formisoft trial, then select the Clinical Trial Payment Agreement Form from the template library. The form is ready to use immediately, but you can customize every field, add your practice logo, and adjust the layout to match your workflow.