Consent Form for [Name of Study]

Amend this model consent form for your project.

Please tick the appropriate boxes

I have read and understood the project information sheet..………………….……………………

I have been given the opportunity to ask questions about the project……………………………

I agree to take part in the project. Taking part in the project will include (indicate form of participation e.g. being interviewed and recorded (audio or video))……………………………………………………………………………………………………

I understand that my taking part is voluntary; I can withdraw from the study at any time up until [give withdrawal date] and I will not be asked questions about why I no longer want to take part……………………………..

Select only one of the next two options:

I would like my name used where I have said or written as part of this study will be used in reports, publications and other research outputs so that anything I have contributed to this project can be recognised…………………………………………………

I do not want my name used in this project……………………………………………………………………………………………..

I understand my personal details such as phone number or address will not be revealed to people outside of this project………………………………………………………………………….

I understand that my words may be quoted in publications, reports, web pages, and other research outputs but my name will not be used unless I requested it above……………………

I agree for the data I provided to be archived and made available to other researchers on request……………………………

(more detail may be provided here so that decisions can be made separately about audio, video, transcripts etc.)

I understand that other researchers will have access to these data only if they agree to preserve the confidentiality of these data……………………………………………………………

I understand that other researchers may use my words in publications, reports, web pages and other research outputs……………………………………………………………………………

I agree to assign the copyright I hold in any materials related to this project to [name of researcher]………………………………………………………………………………………………

On this basis I am happy to participate in the [name of project] study

Name of Participant ………………………… Signature………………………… Date………….

Name of Researcher………………………… Signature………………………… Date………….

If you have any queries or concerns, please contact: [insert names, phone, email address etc]

One copy to be kept by the participant, one to be kept by the researcher