Research Participation Consent Form

EXAMPLE

THIS IS NOT IN USE
We are going to put the participation response slip on this page to use with a digital signature. We will use HelloSign.com  or Docusign.com or a similar E-signature digital verification software.

                                                                          

EXAMPLE CONSENT FORM

De Montfort University

Vanessa Kimbell is carrying out the research as part of a MSc on Nutrition and digestibility of bread.

Title of project: Nutrition & digestibility of Bread – Sourdough and the effect on the gut microbiome & mood

Name of researcher: Vanessa Kimbell

Please initial all boxes if you agree

 

1. I confirm that I have read and understood the information sheet [date and

version number] for the above study. I have had the opportunity to consider the information, ask questions and have had these answered satisfactorily.

 

2. I understand that my participation is voluntary and that I am free to withdraw

at any time without giving any reason.

 

3. I agree that non identifiable quotes may be published in articles or used in

conference presentations.

4. I agree to the interview being digitally audio recorded
5. I understand that data collected during the study may be looked at by a

supervisor from De Montfort University. I give permission for the supervisor to have

access to my data.

 

6. I agree to take part in this study

 

 

_________________________               ________________               _____________

Print name of participant                         Date                                       Signature

 

_________________________               ________________               _____________

Print name of person taking consent      Date                                       Signature

 

 

 

 

 

 

Consent form date of issue: [date]

Consent form version number: [version]