Sample Informed Consent Form printable pdf download

Sample Informed Consent Form

INFORMED CONSENT GUIDELINES

Your informed consent form must include the following:

Title of the Study:

Purpose and description:

Statements outlining in lay language the purpose of the research. Also indicate if the

study is being conducted in partial fulfillment of a degree.

Procedures:

A description of what will be done in the study and how long the procedure will take (eg

questionnaire/interview and the timeframe for completion of procedure)

Risks:

Explicit statements about any risks or discomfort to the participant, with an assessment of

the degree of risk and viable alternatives

Benefits:

Explicit statements about any benefits to the participant, or to the wider society

Right to withdraw or refusal to participate:

A statement that the subject’s participation is voluntary and that refusal to participate or

(if after having agreed to participate) withdrawal from the study at any time will not

affect the participant’s access to or the type of care to which he or she is entitled

Confidentiality:

A statement on how participant’s anonymity will be maintained

Compensation:

A statement that addresses whether or not compensation will be given for participating in

the study. If compensation is given, the monetary amount/incentive should be stated.

Contact Details for Researcher/Principal Investigator

The following statement must be included: “If you have any questions regarding the

research project, you may contact the principal investigator; (Name, address, e-mail

address and telephone number)”.

Rights as a Research Participant:

The following statement must be included: “For independent advice on your rights as a

research participant please contact Professor Horace Fletcher, Dean, Faculty of Medical

Sciences, University of the West Indies, Mona, Kgn 7 (Tel: (876) 927-1297, e-mail:

medsci@uwimona.edu.jm)”.

Sample Informed Consent Form