Data Sharing and Confidentiality Consent Form

Please read the following consent form carefully. By filling and signing below, you acknowledge your understanding and agreement regarding the sharing and confidentiality of your data.

Personal Information

Consent Agreement

I understand that my data may be shared for the purposes described below, and that all reasonable measures will be taken to ensure confidentiality. I can withdraw my consent at any time by contacting the data controller.

Purpose(s) of Data Sharing

Parties with Whom Data May Be Shared

Confidentiality Measures

I agree to the data sharing and confidentiality terms above.

Signature

Date Signed