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Informed Consent Form for Research Study

This document outlines an informed consent form for participation in a research study. It details the purpose of obtaining consent, ensuring voluntary participation and the right to withdraw at any time. It addresses risks and benefits to participation. Confidentiality is assured through use of codes and secure storage of personal information. Contact information is provided for questions about the research or participant rights. Signatures are required from the participant, researcher, and witness to confirm informed consent.

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Mark Jude Gapuz
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169 views2 pages

Informed Consent Form for Research Study

This document outlines an informed consent form for participation in a research study. It details the purpose of obtaining consent, ensuring voluntary participation and the right to withdraw at any time. It addresses risks and benefits to participation. Confidentiality is assured through use of codes and secure storage of personal information. Contact information is provided for questions about the research or participant rights. Signatures are required from the participant, researcher, and witness to confirm informed consent.

Uploaded by

Mark Jude Gapuz
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Informed Consent Form

PURPOSE OF THE STUDY


You are being invited to take part in a research study. Before you decide to participate
in this study, it is important that you understand why the research is being done and
what your participation will involve. Please read the following information carefully
and feel free to ask the researcher if there is anything that is not clear or if you need
more information.

VOLUNTARY PARTICIPATION
Your participation in this study is voluntary. It is up to you whether or not you decide
to participate. If you decide to participate, you will be asked to sign this consent form.
After you sign this consent form, you are still free to withdraw at any time and
without giving a reason. Withdrawing from this study will not affect the relationship
you have, if any, with the researcher. If you withdraw from the study before data
collection is completed, your data will be destroyed.

RISKS
You may decline to answer any or all questions and you may withdraw your
participation at any time if you choose.

BENEFITS
There will be no direct benefit to your participation in the study. However, we hope
that the information from this study may help you.

CONFIDENTIALITY
Your responses in this research will be anonymous. Every effort will be made by the
researcher to preserve your confidentiality, including the following:

1. Assigning codes/psuedonyms for participants that will be used on all research notes
and documents
2. Keeping notes, interview transcriptions, and any other personal identifiers in a
locked cabinet that only the researchers will have access to if the research is sensitive
and/or involves participants who are highly vulnerable, explain any extra precautions
you will take to ensure safety and anonymity.

CONTACT INFORMATION
This study was approved by the Research Ethics Review Committee. If you have any
questions at any time about this study, or if you experience any non-normative
sensations as a result of participation, you may contact the researcher whose contact
information is on the first page. If you have any questions regarding your rights as a
research participant, or if problems arise.
CONSENT

I have read the provided information, or it has been read to me. I have had the
opportunity to ask questions about it and any questions I have been asked have been
answered to my satisfaction. I understand that I will be given a copy of this form, and
the researcher will keep another copy on file. I consent voluntarily to be a participant
in this study.

Print Name of Participant__________________


Signature of Participant ___________________
DateDay/month/year:________________

Print Name of Researcher: _____________________


Signature of Researcher: _______________________
Date Day/month/year: __________________

Print Name of Impartial Witness: __________________


Signature of Impartial Witness: _________________
Date Day/month/year: ________________

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.
Print name of witness: ________________
Signature of witness : __________________
Date Day/month/year: __________________

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