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Informed Consent

This document is a certificate of consent for participation in research. It details that the participant has been informed about the research, had an opportunity to ask questions, and provides consent voluntarily. If the participant is illiterate, a witness must be present who is unaffiliated with the research team. The researcher confirms that the participant understood they could withdraw consent at any time and were not coerced into participation.

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81 views2 pages

Informed Consent

This document is a certificate of consent for participation in research. It details that the participant has been informed about the research, had an opportunity to ask questions, and provides consent voluntarily. If the participant is illiterate, a witness must be present who is unaffiliated with the research team. The researcher confirms that the participant understood they could withdraw consent at any time and were not coerced into participation.

Uploaded by

yooyo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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CERTIFICATE OF CONSENT

I have read the foregoing information, or it has been read to me. I have had the opportunity to ask
questions about it and any questions that I have asked have been answered to my satisfaction. I
consent voluntarily to participate as a participant in this research.

Print Name of Participant: ………………………………….

Signature of Participant: ………………………………….

Date: ………………………………….

If illiterate:

A literate witness must sign (if possible, this person should be selected by the participant and should
have no connection to the research team). Participants who are illiterate should include their thumb-
print as well.

I have witnessed the accurate reading of the consent form to the potential participant, and the
individual has had the opportunity to ask questions. I confirm that the individual has given consent
freely.

Name of witness: …………………………………. AND Thumb print of


participant

Signature of witness: ………………………………….

Date: …………………………..
STATEMENT BY THE RESEARCHER/PERSON TAKING CONSENT

I have accurately read out the information sheet to the potential participant, and to the best of my
ability made sure that the participant understands that the following will be done:

1. NO MEDICATION OF INVESTIGATION IS INVOLVED IN THE STUDY.

2. THE SUBJECT CAN OPT OUT OF THE STUDY ANY TIME.

I confirm that the participant was given an opportunity to ask questions about the study, and all the
questions asked by the participant have been answered correctly and to the best of my ability. I
confirm that the individual has not been coerced into giving consent, and the consent has been given
freely and voluntarily.

A copy of this certificate of consent has been provided to the participant.

Name of Researcher/person taking the consent: …………………………………

Signature of Researcher /person taking the consent: …………………………………

Date: …………………………………

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