Consent to Take Part in a Research Study
Study title: [study title]Researcher: [researcher's name]
Key information about this study
You are being asked to take part in a research study. Taking part is voluntary — it is your choice. This section sums up the most important facts; more detail follows.
- Why we are doing this study: [Explain the purpose of the study in one or two sentences.]
- What you will do: [Describe what participants will do, step by step.]
- How long it will take: [time commitment].
- Main risks: [Describe each foreseeable risk or discomfort, or say that none are expected beyond those of everyday life.]
- Possible benefits: [Describe any benefit to participants or to others. If there is no direct benefit, say so.]
- Your other choices: Your alternative is not to take part in this study.
Why is this study being done?
This is a research study. [Explain the purpose of the study in one or two sentences.]
What will I be asked to do?
[Describe what participants will do, step by step.]
Taking part will take [time commitment].
What are the risks or discomforts?
[Describe each foreseeable risk or discomfort, or say that none are expected beyond those of everyday life.]
What are the possible benefits?
[Describe any benefit to participants or to others. If there is no direct benefit, say so.]
What other choices do I have?
Your alternative is not to take part in this study.
How will my information be kept private?
[Explain where identifying records are kept, who can see them, and when identifiers are deleted.]
Will my information be used for future research?
Your information collected for this study will not be used or shared for future research studies, even if information that could identify you is removed.
What if I do not want to take part, or want to stop?
Taking part in this study is voluntary. You can decide not to take part, and you can stop at any time. If you decide not to take part, or you stop, there will be no penalty, and you will not lose any benefits you are otherwise entitled to.
Who can I contact with questions?
If you have questions about this study, contact [researcher's name] at [email or phone].
If you think you have been harmed by taking part, contact [researcher's name] at [email or phone].
If you have questions about your rights as a research participant, or want to talk to someone outside the research team, contact [IRB or ethics office] at [IRB email or phone].
Statement of consent
I have read this form, or had it read to me. I have had the chance to ask questions, and my questions have been answered. I am at least 18 years old, and I agree to take part in this study.
Participant's name (printed): ______________________________
Participant's signature: ______________________________ Date: ____________
Name of person obtaining consent: ______________________________
Signature of person obtaining consent: ______________________________ Date: ____________
You will be given a copy of this form to keep.