Consent form: Example 1

Title of project

Name of researcher

CONSENT FORM

Please initial box

1.I confirm that I have read and understood the information sheet

dated [...] for the above study and have had the opportunity

to ask questions.

2.I understand that my participation is voluntary and that I am free to

withdraw at any time without giving any reason.

3.I agree to take part in the above study.

______

Name or initials of participantDateSignature or initials

______

Name of person taking consentDateSignature

(if different from researcher)

Consent form: Example 2

Title of project

Name of researcher

Consent Form

Please initial box

1.I confirm that I have read and understood the information sheet

for the above study and have had the opportunity

to ask questions.

2.I understand that my participation is voluntary and that I am free to

withdraw at any time without giving any reason.

3.I agree to take part in the above study.

4. I consent to the recording of the interview.

[Add in any other aspects of the procedure that require specific consent]

______

Name or initials of participantDateSignature or initials

______

Name of person taking consentDateSignature

(if different from researcher)

Consent form: Example 3

for use with self-report questionnaires (can be adapted for on-line surveys)

...Before starting the questionnaire, you are asked to read the next page and tick the appropriate boxes to indicate that you consent to taking part.

------

CONSENT

Please tick the boxes to indicate that you give your consent for us to include your responses in our study. If you do not do this, we will not be able to make use of your responses, even if you return the questionnaire to us.

___I confirm that I have read and understood the Information Sheet that was included with this questionnaire.

___I have had a chance to think about the information, and was able to contact the researchers for more details if I wished (even if I did not make this contact).

___I understand that my responses to this questionnaire will be included in the results, and will therefore be represented in the final report. The results may also be published elsewhere. However, it will not be possible to identify me in any way from these results.

___I understand that any information that I give that might identify me will be held securely and will not be disclosed to anyone outside of the research team.

___I agree to take part in this study by answering some or all of the questions in this questionnaire.

Consent FORM: Example 4

[NAME OF STUDY] consent form

PLEASE INITIAL BOTH COPIES OF THE CONSENT FORM WHERE INDICATED. THEN PLACE ONE COPY OF THE INITIALLED CONSENT FORM INSIDE THE ENCLOSED STAMPED ADDRESSED ENVELOPE TO BE RETURNED TO THE RESEARCHERS ALONG WITH THE QUESTIONNAIRE BOOKLET. PLEASE RETAIN ONE COPY OF THE CONSENT FORM FOR YOURSELF.

(Researcher use only)

Participant identification number:

Title of project:

Name of Researcher:

Please initial box

1.I confirm that I have read and understood the information sheet dated [...] (version x)

for the above study. I have had the opportunity to consider the information, ask

questions and have had these questions answered satisfactorily.

2.I understand that my participation is voluntary and that I am free to withdraw at any

time without giving any reason, without any medical care or legal rights being affected.

3.I agree to take part in the above study conducted by the Department of Psychology at

Glasgow Caledonian University.

  1. I agree to my questionnaire data being used for the purposes outlined in the information

sheet (journal publications, presentations, reports, the media).

Please provide initials here _____Date: ______

Initials of person (study researcher) taking consent: _____Date: ______

CONSENT FORM: EXAMPLE 5

NAME OF RESEARCH PARTICIPANT CODE NO.

TITLE OF THE RESEARCH STUDY

CONSENT TO TAKE PART IN THE STUDY

I,………………………………………………(put your name in here)

agree to take part in the research study being carried out by the School of XXX at Glasgow Caledonian University. I have read the information sheet and have had chance to discuss it.

I understand that:

  • I do not have to take part in the research if I don’t want to.
  • If I change my mind and decide to withdraw from the research at any stage after signing this form, I can. I do not have to give a reason or sign anything to do so.
  • If I decide to withdraw from the research study, this will not influence any help or treatment I get in any way.
  • The information kept on me will be treated as strictly confidential and will be stored securely.
  • Any information I give will be used for research only and will not be used for any other purpose.

SIGNATURE ……………………………………………………………DATE:………………………………

WITNESSED ……………………………………………………………DATE:………………………………

CONSENT: EXAMPLE 6

Example for anonymous self-report questionnaire, to be inserted after the cover page, before the start of questions.

CONSENT

Please tick the boxes to indicate that you give your consent for us to include your responses in our study. If you do not do this, we will not be able to make use of your responses, even if you return the questionnaire to us.

[ ] I confirm that I have read and understood the Information Sheet that was included with this questionnaire.

[ ] I have had a chance to think about the information, and was able to contact the researchers for more details if I wished (even if I did not make this contact).

[ ] I understand that my responses to this questionnaire will be included in the results, and will therefore be represented in the final report. The results may also be published elsewhere. However, it will not be possible to identify me in any way from these results.

[ ] I understand that any information that I give that might identify me will be held securely and will not be disclosed to anyone outside of the research team. [Clarify here limits of access.]

[ ] I agree to take part in this study by answering some or all of the questions in this questionnaire.

[add in any other points relevant to the study]