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Consent Form VAMC

This document is a Written Informed Consent form for participants in a research study, outlining the purpose, procedures, benefits, and risks involved. It emphasizes the voluntary nature of participation and the confidentiality of results. Participants are required to acknowledge their understanding and consent by signing the form.

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saicharan.kandiboina
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16 views4 pages

Consent Form VAMC

This document is a Written Informed Consent form for participants in a research study, outlining the purpose, procedures, benefits, and risks involved. It emphasizes the voluntary nature of participation and the confidentiality of results. Participants are required to acknowledge their understanding and consent by signing the form.

Uploaded by

saicharan.kandiboina
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

Written Informed Consent form

Part I- Information for participants of the study

Study title:

......................................................................................

.........................................

Dear Respondent,

Before you participate in this study, it is important for you to understand why this is being
carried out. If you have any doubts regarding the procedure and purpose of the study or if
you want more information, you are free to ask the contact person mentioned below.

What is the purpose of the study?

Why have you been chosen?

Do you have to take part?

What will happen to you if you take part?

What do you have to do?


What is the procedure or drug that is being tested?

What are the alternatives for diagnosis or

treatment?

What are the possible benefits of taking part?

What are the possible disadvantages or risks of taking part?

What if new information becomes available?

Will your taking part in the study be kept confidential?

What will happen to the results of the study?

Who is organizing the research study?

Who has reviewed the study?


Contact for further

information:

CONTACT PERSON:
Name of the Principal Investigator
:Designation
Name of the Institute
(Phone and email ID of the Investigator)
Ph.: xxxxxxxx, Email-xxxxxxxxxxxxxxx

Thank you for taking your time to participate in the study.

Date:

Signature of investigator

Place:

Signature of witness

Part II: Consent form


Participant’s name:

Address:

Title of the study:


___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

The details of the study have been provided to me in writing and explained to me in my own
mother tongue. I confirm that I have understood the purpose and procedure of the above
research study. I understand that my participation in the study is voluntary and that I am free
to withdraw from the study at any time, without giving any reason whatsoever. I was assured
that the result of the study will be used only for scientific purpose(s), and the results and
photographs may be published later and I will not restrict the use of the results. I have also
received a copy of the consent form giving the “Information for participants of the study”. I
fully consent for my participation in the above mentioned study.

Signature/Left thumb impression of the participant:

Date:

Signature/Left thumb impression of the witness:

Date:

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