Psychological Study Consent Form

Study Title:

Principal Investigator:

Contact Information:

Purpose of the Study

Procedures

Possible Risks and Discomforts

Benefits

Confidentiality

Voluntary Participation and Withdrawal

Contact for Questions

Consent

• I have read and understood the information provided above.
• I have had the opportunity to ask questions and receive answers.
• I voluntarily agree to participate in this study.

Participant Name Date

Participant Signature

Researcher Signature