Sample of Implied Consent Letter for Surveys Or Questionnaires

LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER in Shreveport Institutional Review Board (IRB) for the Protection of Human Research Subjects

CONSENT LETTER

Sample of Consent Letter for Surveys or Questionnaires Please remove all blue text before submitting

Title of Study

You are invited to participate in a study of ... state what is being studied. I hope to learn ... state what the study is designed to discover or establish.

You were selected as a possible participant in this study because ... state why and how the subject was selected. You must be 18 years of age or older to participate.

The (survey or test) is designed to ... explain purpose of survey or test. It will take about ... length of time expected to complete survey or test.

No direct benefit will accrue to you for completing the survey or test, but your responses will be used to ... explain research benefit.

If you decide to participate, please do the following: Include any specific instructions for completing the survey or test.

Your decision whether or not to participate will not influence your current or future relationships with LSUHSC-Shreveport.

Include this statement if applicable. Please do not put your name on this form. No personal identifiers will be collected.

WHAT ABOUT CONFIDENTIALITY? Efforts will be made to keep your personal information confidential. We cannot guarantee absolute confidentiality.

Please feel free to ask questions regarding this study. You may contact me later if you have additional questions or concerns at ... telephone number and e-mail address of investigator conducting the study.

You may also contact the Human Research Protection Program (which is a group of people who review the research to protect your rights) or the Institutional Official of LSUHSC-S at (318) 813-1356 ( http://www.lsuhscshreveport.edu/HRPP/HRPPContactUs.aspx ) for:

 additional help with any questions about the research  voicing concerns or complaints about the research  obtaining answers to questions about your rights as a research participant  concerns in the event the research staff could not be reached  the desire to talk to someone other than the research staff

Thank you for your time.

Sincerely,

Research Title Researcher’s Name

Version (Letter Page 1