Administration Centre CFAS
Institute of Public Health
Forvie Site, University of Cambridge
School of Clinical Medicine
Cambridge Biomedical Campus
Cambridge, CB2 0SR
T: 01223 330312
F: 01223 762515
W: www.cfas.ac.uk
Project No...........................................................
Name of Respondent...........................................................
Please Initial
I confirm that I have read and understood the information sheet for relatives and carers (version 2 dated 19/02/2015) for the above study and have been given a copy to keep.
I have had the opportunity to ask questions about the study and have received answers to my questions.
I agree to conduct an informants interview and give information on my
( Enter relationship to informant ) …………………………………………………….’s health and wellbeing.
Consultee: Name….………………………………………………………. Signature………………………………………………..
Relationship to respondent: ……………………………………………………………………………………………
Address …………………………………………………………………………………………………………………………..
…………………………………………………………………………………………………………………………………………
Interviewer: Name………………………………………………. Signature…………………………………………
Date: ……………………………………
A Collaborating Centre in the Cognitive Function & Ageing Study
Consultee Consent to Informant Interview: Version 2: 19/02/2015