What You Need to Know to Participate
This document provides information to help you decide whether to join this research study. It is important you understand the responsibilities, risks and benefits of participating.
Informed Consent Form
Project Title:
Understanding Community Health Behaviors
Principal Investigator:
Dr. Jane Smith, Department of Public Health
Contact Information:
Email: jane.smith@university.edu
Phone: (555) 123-4567
Purpose of the Study:
You are invited to participate in a research study about health behaviors in our community. The purpose of this study is to better understand how people make health-related decisions.
Procedures:
If you agree to participate, you will be asked to complete a survey that will take approximately 20 minutes. The survey will include questions about your health habits, access to healthcare, and general well-being.
Risks and Benefits:
There are minimal risks associated with participating in this study. You may skip any questions you do not wish to answer. The information gathered may help improve community health programs.
Confidentiality:
All information you provide will be kept confidential. Your responses will be coded and stored securely. No identifying information will be included in any reports or publications.
Voluntary Participation:
Your participation is entirely voluntary. You may refuse to participate or withdraw from the study at any time without penalty or loss of benefits.
Questions:
If you have any questions about this study, please contact Dr. Jane Smith at the contact information above.
Consent Statement:
By signing below, you acknowledge that you have read and understood the information provided, and you agree to participate in this study.
Participant Name (printed): ___________________________
Participant Signature: ________________________________
Date: ___________________
Researcher Signature: ________________________________
Date: ___________________