Informed Consent (Sample 1)
Title: ------------
Lead Principal Investigator: ------------Background
Introduction:
You are invited to participate in a -------------------------------------------------------------We need some information about -------------------------------------------------------------Your help is highly appreciated and important to complete this study.
It is entirely your decision whether to participate in this study or not. You may withdraw at any
stage you like.
This study will not require names or personal identity and participation in the study is
completely anonymous and voluntary
You may not benefit from being a part of this study but your participation may help to improve
conservation policy in your country.
Purpose of the study:
The purpose of the study ----------------------------------------Benefits, Risks, and Discomforts: -----Confidentiality:
Any information from you will remain confidential between you and the University
researchers. You will not be identified as a study participant in any reports or
publications of this study. The information will be stored at ------Questions or Problems?
In the event that you have any questions about this study you can contact --------I HAVE READ THE EXPLANTION ABOUT THIS STUDY. I HAVE BEEN GIVEN THE OPPORTUNITY TO
DISSCUSS IT AND MY QUESTIONS HAVE BEEN ANSWERD TO MY SATISFACTION. I WILLINGLY
GIVE MY CONSENT TO PARTICIPATE IN THIS STUDY.
Participant Signature
Date
Investigator Signature
Date
Consent Form (Sample 2)
Date:----Dear Participant:
This survey questionnaire is an attempt to ----------------------------------------------------------------------------------------------------- Your input is an essential element in this study and
will be kept strictly confidential. This information will be used for research purposes
only. Of course, your participation is voluntary. If you decide to participate, you will be
asked to ………………………………….. This will take approximately ----------- minutes from your valuable time. We appreciate your time and effort. If you have any
questions about this study, please feel free to contact me. If you would like to have a
summary of the results. Please e-mail us at ……………………….
Sincerely,
……………
……………..
I have read the above statements and have been fully advised of the procedures to be used
in this project. I have been given sufficient opportunity to ask any questions I had
concerning the procedures and possible risks involved. I understand the potential risks
involved and I assume them voluntarily. I likewise understand that I can withdraw from
the study at any time without being subjected to reproach.
______________
Name
____________
Date
CONSENT FORM (Sample 3)
I have been fully informed about the aims and purposes of the project.
I understand that:
There is no compulsion for me to participate in this research project and, if I do
choose to participate, I may at any stage withdraw my participation
I have the right to refuse permission for the publication of any information about me
Any information which I give will be used solely for the purposes of this research
project, which may include publications
If applicable, the information, which I give, may be shared between any of the other
researcher(s) participating in this project in an anonymised form
All information I give will be treated as confidential
The researcher(s) will make every effort to preserve my anonymity
............................………………..
................................
(Signature of participant)
……………………
(Printed name of participant)
One copy of this form will be kept by the participant; a second copy will be kept by the
researcher(s)
Contact phone number of researcher(s): --------------------------Contact email: ---------------------
(Date)
Consent Form (Sample 4)
You are invited to participate in a research study entitled ---------------------------------------------------------------------------. This study is being conducted by ------------------------------------------------------------------------------------- from Qatar University College of ---------------- with approval from the
Supreme Council of Health.
The goal of this study is to ----------------------------------------------------------------------------------------------------------------- Your contribution in this study is very valuable for the -----------------------------.
There will be no immediate benefit to you for your participation in this study. However, the
information gathered from this research will provide benefit for -----------------------------------------------------.
There are no known risks if you decide to participate in this research study. There are no costs
associated with your participation in this study.
Your participation in this study is voluntary. If you agree to participate, you will have the
opportunity to withdraw your consent at any time from this study. If you decide not participate in
this study, the data collected from you so far will not be documented for study purposes.
If you decide to participate in this study, the research team will document data regarding the ------------------------------------------------------------------. The information you provide will only be used for
study purposes and will not be used against you or result in any negative consequences.
The study will take approximately -------------- minutes/hour(s) to complete. The information
collected will be confidential. The research team will not record your name during this process.
No one will be able to identify you or your answers, and no one will know whether or not you
participated in the study.
Upon completion of this study, you will have the opportunity to see the study results. The
results will be disseminated in a---------- (e.g. poster, presented at a conference), and/or published
in a journal. If the data is published, no individual information will be disclosed.
If you have any questions about the study, please contact Dr. ---------------------Professor , Qatar University, College of ------------, PO BOX 2713, Doha Qatar;
Phone: -----------------, Email: ----------------By signing this consent form, you are stating that you agree to participate in this study and that
you have read and understood the information that has been provided above, and have
received a copy of the this form. You are also stating that you will not share your experience or
details regarding the study with others until the end of the study period (---------) since this may
affect the results of the study.
Printed name:
Signature:
Date:
Consent Form for Interview including Taping of Interview (Sample 5)
Lead Principal Investigator: -------------------------Address:
Phone:
Email:
My name is ____________________, and I am a research assistant in a collaborative study with
researchers from Qatar and ………………….
You are being requested to participate in a research study which aims to --------------------------------------------------------------------------------------I would like to explain the study before you decide whether or not you would like to participate. Please
stop me at any time if you have any questions.
The study involves interviews with ----------------------------Participation should take about --------------- of your time. Participation is voluntary. If you wish to
refrain from answering any particular question, you may do so during the interview.
I would like to tape record this interview in order to ensure that all the information you provide is
accurately documented. You may still participate in the interview if you do not want the interview to be
recorded.
All data collected is treated as confidential information. Your name or any identifiers will not appear in our
research write- up. All data shared with the research team are aggregated data and have no identifiers that
could be linked to your personal responses. All completed interviews will be kept in locked files in the ---------------- offices or password protected computers.
You will not be penalized in any way for deciding to skip a question or withdraw at any time. You also will
not be affected professionally if you refuse to participate. There are also no direct benefits to you
personally if you choose to participate. However, this research will contribute to ---------------------------------------------------------------------------You will be invited to future debriefing sessions to share and validate findings from this research.
If you have any questions, you are free to ask them now. If you have questions later, you may contact the
above named, or :
…………………
…………………
Do you voluntarily consent to take part in the study?
Yes
No
If Yes, signature ____________________________.
Consent to Record Interview
Do you also voluntarily consent to this interview being recorded?
Yes
No
If Yes, Signature:____________________________.
If you chose to be interviewed, you will be given a copy of this consent form with your
signatures.
Your participation is completely voluntary. You may withdraw from this study at
any time without penalty.
All information obtained in this study will be kept strictly confidential and anonymous.
The data will be stored in secure lockable filing cabinets in the research team’s individual
offices. The electronic data will be stored on secure password protected computers to
which only the research team will have access. Each respondent will be given an ID
number which will be used for all transcription of data from the interview forms. The
identity of the respondent will only be known to the members of the research team who
will keep this information completely confidential. The results of this study will be
presented as a group and no individual participants will be identified without their
permission.
If you agree to participate, please let me know of a convenient time and place for the
interview. If you are interested in receiving the final copy of the research project, kindly
provide me your mailing/email address.
This research has been reviewed and approved by the Qatar University Institutional
Review Board. If you have any questions or concerns about this study, you may contact
QU–IRB (provide contact information and email, telephone of QU–IRB). Contact
information of the research team is as follows:
Name: ---Email: ----Telephone: -------Name: ---Email: ----Telephone: -------Name: ---Email: ----Telephone: --------