CONSENT FORM
for
OWNERS
Research Project:
I, ……………………………………………………………………….., have read
the information contained in the Information Sheet for Owners and any
questions I have asked have been answered to my satisfaction.
Yes/No
I agree to participate in this study, realising that I may withdraw my
???? at any time.
Yes/No
I agree that research data gathered for the study may be published.
Yes/No
I agree that you can take a small blood sample from my ???? both
before and after surgery.
Yes/No
I agree that my ???? can have hair removed both before and after
surgery.
Yes/No
I understand that the researchers will not be held responsible should
anything untoward happen during the surgery.
Yes/No
I am older than18 years of age.
Yes/No
……………………………..
Owner
………………………….
Date
……………………………..
Researcher
………………………….
Date