Participant No.

INFORMED CONSENT FORM:

Before you decide to take part, you must read the accompanying Participant Information Sheet.

Please do not hesitate to ask questions if anything is unclear or if you would like more information about any
aspect of this research. It is important that you feel able to take the necessary time to decide whether or not you
wish to take part.

If you are happy to participate, please confirm your consent by circling YES against each of the below
statements and then signing and dating the form as participant.

1 I confirm that I have read and understood the Participant Information Sheet for
the above study and have had the opportunity to ask questions YES NO
2 I understand my participation is voluntary and that I am free to withdraw my data,
without giving a reason, by contacting the lead researcher and the Research
YES NO
Support Office at any time until the date specified in the Participant Information
Sheet
3 I have noted down my participant number (top left of this Consent Form) which
may be required by the lead researcher if I wish to withdraw from the study YES NO
4 I understand that all the information I provide will be held securely and treated
confidentially YES NO
5 I am happy for the information I provide to be used (anonymously) in academic
papers and other formal research outputs YES NO
6 I am happy for the interview to be audio recorded
YES NO

7 I agree to take part in the above study

[FOR CU INTERNAL INFORMATION ONLY PLEASE DELETE ALL BROWN AND RED TEXT PRIOR TO USE. THE
ABOVE STATEMENTS SHOULD BE AMENDED AS APPROPRIATE – E.G. 5 SHOULD READ ‘I am happy for the information
I provide to be attributed directly to me in any formal research outputs ’ IF THIS IS THE CASE. ADDITIONAL
DECLARATIONS SHOULD BE INCLUDED AFTER POINT 5 IF PERSONAL DATA ARE TO BE SHARED WITH 3 RD
PARTIES AND/OR TRANSFERRED OUTSIDE THE EEA…SUGGESTED WORDINGS - ‘I understand and agree that the
information I provide may be shared with the following third parties: [SPECIFY]’; ‘I understand and agree that my personal data
may/will [DELETE AS APPROPRIATE] be transferred outside of the EEA, and that I may not receive the same level of data
privacy protection as in the UK’. IF THERE IS MORE THAN ONE DEFINED PURPOSE TO THE STUDY, A SEPARATE
CONSENT DECLARATION SHOULD BE INCLUDED FOR EACH]. Thank you for your participation in this study.
Your help is very much appreciated.

Participant’s Name Date Signature

Researcher Date Signature

Consent form