Audio/Video Recording Consent Form

Study Title:

Researcher(s):

Participant Name:

Purpose of the Study

Use of Audio/Video Recordings

Confidentiality

Consent

I agree to the audio recording of the interview. I agree to the video recording of the interview. I understand that my participation is voluntary and I can withdraw at any time. I have had the opportunity to ask questions regarding the study and recording.

Additional Comments:

Participant Signature: Date:

Researcher Signature: Date: