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Study ID:IRB201300459 Date Approved: 1/10/2014 Expiration Date: 1/8/2015 INFORMED CONSENT FORM to Participate in Research INTRODUCTION Name of person seeking your consent: Place of employment & position:
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How to fill out informed consent form

How to fill out an informed consent form?
01
Read the form carefully: Start by carefully reading the entire informed consent form to understand its purpose, the study or procedure involved, and the potential risks and benefits.
02
Ask questions: If you have any doubts or concerns about the information provided in the form, don't hesitate to ask the person providing it. Clarify any uncertainties and ensure you have a clear understanding of what you are consenting to.
03
Provide accurate personal information: Fill out the personal details section of the form accurately, including your full name, date of birth, address, and contact information. This ensures that the consent form is correctly associated with you as the participant or patient.
04
Understand the purpose: Make sure you understand the purpose of the study or procedure. Read through the explanation provided in the form and ask for further clarification if necessary. It is essential to have a clear understanding of why the study or procedure is being conducted.
05
Comprehend the risks and benefits: The informed consent form should outline the potential risks and benefits associated with the study or procedure. Read this section carefully to fully grasp what you might experience and the potential positive outcomes. Assess if the potential benefits outweigh the risks and decide if you are comfortable proceeding.
06
Consent statement: Sign and date the consent statement at the end of the form if you agree to participate or undergo the procedure. This signature indicates that you have read and understood the information provided, and you voluntarily give your consent to participate.
Who needs an informed consent form?
01
Research participants: Those who are involved in research studies, whether medical, social, psychological, or scientific in nature, typically need to complete an informed consent form. This ensures that they are aware of the purpose, risks, and benefits of the study and voluntarily choose to participate.
02
Patients or individuals undergoing medical procedures: Informed consent forms are necessary for medical interventions, surgeries, or any diagnostic or therapeutic procedures. Patients must understand the procedure, its potential risks and benefits, and give their consent before the healthcare professional can proceed.
03
Legal or financial agreements: In various legal or financial situations, informed consent forms may be required. For example, when signing contracts, accepting a loan, or making a purchase involving risks or obligations, an informed consent form may be used to ensure both parties are aware of the terms and agree to them willingly.
Remember, the specifics may vary depending on the context and jurisdiction, so always ensure you follow the guidelines and instructions provided by the relevant institution or organization.
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What is informed consent form?
Informed consent form is a document that provides detailed information to a patient about a specific medical procedure or treatment, including risks and benefits, before the patient agrees to undergo the procedure.
Who is required to file informed consent form?
Healthcare providers are required to have patients sign informed consent forms before performing medical procedures or treatments.
How to fill out informed consent form?
The healthcare provider typically provides the informed consent form, which the patient must read and sign before the procedure. The patient may ask questions and clarify any doubts before signing the form.
What is the purpose of informed consent form?
The purpose of the informed consent form is to ensure that the patient understands the risks and benefits of a medical procedure or treatment and consents to it voluntarily.
What information must be reported on informed consent form?
The informed consent form must include details about the procedure or treatment, potential risks and complications, alternative options, and the patient's agreement to proceed with the procedure.
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