sampleconsentform.docVIP

Sample Consent Form It is impossible to address all scenarios for the many types of research protocols conducted by UAB researchers. This sample is designed to assist you in the preparation of consent forms. It is intended to show language preferred by the UAB IRB to address the essential elements of informed consent. In many cases, the sample language will need to be modified, deleted, or expanded for the particular study. Shaded paragraphs like this one are instructions for you, the writer. Do not include them in the consent form you submit. If the instructions indicate that specific language applies to your protocol, the specific language will be shown below the instructions outside of the shaded paragraph. Use this sample consent form as a guide for obtaining consent and/or assent from participants 14 years of age and older. Formatting Instructions Use a 12 pt font for the consent form. Write the consent form in the 2nd person (i.e., you) and keep the pronoun usage consistent throughout. Use Page X of Y numbering on each page. Leave an area approximately 1 inch by 2 inches on the bottom of the first page for the IRB approval stamp. Use understandable, non-technical language at an 8th-grade or lower reading level. Readability statistics can be displayed in Microsoft Word. Search Microsoft Office Help for “readability statistics” for further instructions. DELETE THIS FIRST PAGE OF INFORMATION IF YOU ARE USING THIS DOCUMENT TO CREATE YOUR CONSENT FORM.  CONSENT FORM TITLE OF RESEARCH: Evaluation of the Safety and Efficacy of Trimycin vs. Hydrochlorothiazide in the Treatment of Hypertension IRB PROTOCOL NO.: F######### INVESTIGATOR: John Doe, Ph.D. Sponsor: If the protocol is being sponsored by UAB departmental funds or is unfunded, put the name of the department here (e.g., UAB Department of Medicine). For student research, include the student’s departmental affiliation. If no Sponsor protocol number, remove the heading If additiona