Sample Language for Consent Forms

Sample consent forms

Below are sample consent forms that may be used as a template for Minimal Risk surveys on Non-Protected Populations. The information in brackets must be provided but feel free to alter the remaining text to suit your particular needs.

Telephone Script

Hello, my name is [INSERT NAME] from [INSERT INSTITUTION]. I am calling to ask if you would be interested in participating in a research study about [INSERT PURPOSE OF THE STUDY]. It will take approximately [INSERT TIME]. Is this a good time to talk? (If not, ask for a different time). Your responses will be kept confidential, I have not written down your name or phone number on the answer sheet. Feel free to skip any questions that you do not want to answer. Let me give you a number where I can be reached if you have any questions after the study is over [INSERT CONTACT NUMBER]. Are you ready to begin?

Internet Survey Script

Hello, my name is [INSERT NAME] from [INSERT INSTITUTION]. I am a conducting a research study about [INSERT PURPOSE OF THE STUDY]. Would you be willing to take [INSERT TIME] to fill out the survey attached to this introduction? Your responses will be anonymous; there is no way for me to know who filled a survey. Feel free to skip any questions that you do not want to answer. If you have questions about the survey, please feel free to email me at [INSERT CONTACT INFORMATION] (you may also include a phone number or use a phone number instead of an email address). If you choose to participate, please click on I ACCEPT at the bottom of the screen to begin the survey. Thank you in advance for your time.

Pen and Paper Survey Script

Hello, my name is [INSERT NAME] from [INSERT INSTITUTION]. I am conducting a research study about [INSERT PURPOSE OF THE STUDY]. Would you be willing to take [INSERT TIME] to fill out the survey? Your responses will be anonymous; there is no way for me to know who filled a survey. Feel free to skip any questions that you do not want to answer. If you have questions about the survey, please feel free to email me at [INSERT CONTACT INFORMATION] (you may also include a phone number or use a phone number instead of an email address). If you choose to participate, please take a survey packet that includes an self-addressed envelope you can use to mail me the survey. (If appropriate, use “please deposit your survey in the drop box located at [INSERT LOCATION]”). Thank you in advance for your time.