Consent Templates

Consent Templates for Full Committee Review Research

These samples may help investigators draft their study-specific consent forms.  Please be aware that these templates may not be appropriate for all settings. (See *below for minimal risk research.) Please contact the IRB Office for guidance about developing consent forms that are appropriate to your study population. 

Q & A Consent Template for Clinical Trials - FDA Studies - Revised March 2015. Appropriate for FDA-regulated studies, this template is written in a Question and Answer format.

Consent Form Template  2 - Revised 6-23-2008. This template should be used for internal studies and for other projects where all data released to external parties has been de-identified according to HIPAA standards. 

Consent Template Parental Permission - Revised 5-18-2009

Consent Template Child Assent Examples - Revised 1-26-2009

Consent Template for Surrogate Decision-Makers - Revised  3-12-2014. This template is appropriate for persons who are consenting to research on behalf of another adult who does not have decisional capacity.

Consent Template for Emergency Use - 11-11-2014

Consent Template for Pregnant Participant / Partner - Revised 1-29-2015

Consent Template for Optional Sample Storage and Future Use - Revised 1-29-2015

*Consent Templates for Minimal Risk Research

Survey consent form template - anonymous, no HIPAA - 1-28-2015
Survey consent form template - not anonymous, no HIPAA- 1-28-2015
Consent Template for Humanitarian Use Devices - Revised  7-2-2009. Approval for a humanitarian use device (HUD) involves special considerations from FDA and the HSC. Please contact the HSC Office for more information when proposing the use of an HUD. 

Withdrawing Consent 

Template for Withdrawal or Partial Withdrawal of Consent for Research - March 2015

Last modified: Apr 02, 2015
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