Important Information
INFORMED CONSENT FORM (TEMPLATE)
Study Title
Lorem ipsum dolor sit amet, consectetur adipiscing elit.
Principal Investigator
Name: Lorem Ipsum
Organization: Lorem ipsum dolor sit amet
Contact: lorem@ipsum.edu | (000) 000-0000
Study Team / Sponsor (if applicable)
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Sed do eiusmod tempor incididunt ut labore et dolore magna aliqua.
Key Information
You are being asked to consider joining a research study. This section summarizes the most important information.
- Purpose: Lorem ipsum dolor sit amet, consectetur adipiscing elit.
- What you will do: Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt.
- Time commitment: Lorem ipsum dolor sit amet, consectetur adipiscing elit.
- Main risks: Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore.
- Potential benefits: Lorem ipsum dolor sit amet, consectetur adipiscing elit.
- Voluntary: Taking part is your choice. You may stop at any time without penalty.
1) Invitation and Purpose of the Study
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat.
2) Why You Are Being Asked to Participate
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur.
3) What Will Happen if You Join (Study Procedures)
If you agree to participate, you will be asked to do the following:
- Lorem ipsum dolor sit amet, consectetur adipiscing elit.
- Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt.
- Lorem ipsum dolor sit amet, consectetur adipiscing elit.
Duration: Lorem ipsum dolor sit amet, consectetur adipiscing elit.
Number of visits / sessions: Lorem ipsum dolor sit amet.
Location / platform: Lorem ipsum dolor sit amet, consectetur adipiscing elit.
4) Time Commitment
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua.
5) Risks and Discomforts
Taking part in research may involve risks. The risks in this study may include:
- Lorem ipsum dolor sit amet, consectetur adipiscing elit.
- Lorem ipsum dolor sit amet, sed do eiusmod tempor incididunt ut labore.
- Lorem ipsum dolor sit amet, consectetur adipiscing elit, quis nostrud exercitation.
There may be risks that are currently unknown.
6) Benefits
You may or may not benefit from being in this study. Possible benefits include:
- Lorem ipsum dolor sit amet, consectetur adipiscing elit.
- Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt.
Others may benefit in the future from what is learned in this study.
7) Alternatives to Participation
You do not have to participate. Alternatives include:
- Not participating in the study.
- Lorem ipsum dolor sit amet, consectetur adipiscing elit.
8) Costs
Participant costs: Lorem ipsum dolor sit amet, consectetur adipiscing elit.
If any costs are expected, they may include: Lorem ipsum dolor sit amet, sed do eiusmod tempor incididunt.
9) Payment or Compensation (if any)
You will/will not be paid for participating.
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua.
10) Confidentiality and Privacy
We will make reasonable efforts to protect your information.
- What data is collected: Lorem ipsum dolor sit amet, consectetur adipiscing elit.
- How data is stored: Lorem ipsum dolor sit amet, sed do eiusmod tempor incididunt ut labore.
- Who may access data: Lorem ipsum dolor sit amet, consectetur adipiscing elit.
- How results are reported: Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt.
Even with safeguards, no system can guarantee complete confidentiality.
11) Use of Your Data / Future Research (optional)
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat.
☐ YES, my de-identified data may be used for future research.
☐ NO, my de-identified data may not be used for future research.
12) Data Sharing (optional)
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua.
☐ YES, de-identified data may be shared with other researchers.
☐ NO, de-identified data may not be shared with other researchers.
13) Audio/Video/Images (if applicable)
This study will/will not record audio, video, or images.
Lorem ipsum dolor sit amet, consectetur adipiscing elit.
☐ YES, I consent to being recorded (if applicable).
☐ NO, I do not consent to being recorded.
14) Voluntary Participation and Right to Withdraw
Your participation is voluntary. You may choose not to participate or to stop at any time.
- Stopping participation will not affect your relationship with Lorem ipsum dolor sit amet.
- If you withdraw, Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt.
15) When the Researcher May Remove You from the Study
The study team may end your participation without your permission for reasons such as: