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Example Consent Form

This document is a sample consent form for research participants. It explains the purpose and procedures of the research study, and obtains participants' consent to participate and have their data used and stored. Participants initial each section to confirm their understanding and consent. Sections address the study information provided, voluntary participation, use and storage of personal data, anonymity, data retention, potential sharing of data with other organizations, audio/video recording procedures, and agreement to participate.

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13 views1 page

Example Consent Form

This document is a sample consent form for research participants. It explains the purpose and procedures of the research study, and obtains participants' consent to participate and have their data used and stored. Participants initial each section to confirm their understanding and consent. Sections address the study information provided, voluntary participation, use and storage of personal data, anonymity, data retention, potential sharing of data with other organizations, audio/video recording procedures, and agreement to participate.

Uploaded by

foochoo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Example: Consent Form for [Insert Research Participant Group]

This is an example of an informed consent form for a research study. The statements provided on this form are
not exhaustive. You may need to amend the statements or add statements according to your research study.

Title of Study: ______________________________________________________________________


For research involving the NHS:
IRAS ID: _______________
Participant ID: _______________

Thank you for your interest in taking part in this research. Please complete this form after you have read the
Information Sheet and/or listened to an explanation about the research study. You will be given a copy of this
Consent Form.
Please initial box to confirm consent
1.1. I confirm that I have read the information sheet dated [insert date] (version [insert
version]) for the above study, I have had the opportunity to consider the information, ask
questions and I have had any questions answered satisfactorily.
2.2. I understand that my participation is voluntary and that I am free to withdraw at any time
without giving any reason, [without my medical care or legal rights being affected]. I
understand that if I decide to withdraw, any data that I have provided up to that point
will be [specify whether data will be omitted or included].
3.3. I consent to the processing of my personal information [specify what personal
information will be collected] for the purposes of this research study, as described in the
information sheet dated [insert date] (version [insert version]).
4.4. I consent to my [anonymised/pseudonymised] research data being stored and used by
others for future research.
5.5. I understand that my research data may be published as a report.
6.6. (If appropriate) I consent to the retention of my personal information [specify what
personal information will be collected] for X weeks, for the purpose of being re-
contacted.
7.7. (If appropriate) I understand that my research data may be looked at by individuals from
[insert company/organisation/institution name(s)], where it is relevant to my taking part
in this research.
8.8. (If appropriate) I consent to being [audio and/or video] recorded and understand that the
recordings will be [specify storage procedure: destroyed within X weeks after the data has
been collected / destroyed immediately after transcription and/or stored anonymously on
password-protected software and used for research purposes only]. (If appropriate) I
understand that being audio and/or video recorded is optional and therefore not
necessary for my participation in this research.
9. I agree to take part in this research project.
Participant
______________ ______________ ________
Name of participant Signature Date

Researcher
______________ ______________ ________
Name of researcher Signature Date

Consent Form Version XX / Date XX/XX/XXXX


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