Sample of Patient's Informed Consent Form

Admin Posts : 122 Join date : 2009-06-06

Sample of Patient's Informed Consent Form

For legality and in order to protect the both the researcher/s and the respondents, a sample of an Informed Consent Form can be patterned from below that MUST be placed at the bottom of your Data Collecting Tool, Survey Form, Questionaire, etc. Obviously the researcher/s will also need to do an accurate Tagalog (or any other dialect) Translation of this for the researcher/s non-english speaking respondents.

PATIENT’S INFORMED CONSENT FORM

I,___________________________ of legal age, hereby authorize (Researcher's Name) to perform a study on "The Relationship of Culture Based Behaviour and Resource Accessibility with Compliance in Diabetic Regimen”.

During the course of interview, I have the privilege to participate and the power to withdraw at any point during the process of the study.

I affirm that consent was given after detailed explanation of the purpose of this study. I have read, understood and received a copy of this consent, and desire out of my own free will and volition to participate in the said study.

I hereby affix my signature here _____________________________ this day of ______________, 2009 at ___________________.