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 6-24-2015. 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 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. 

*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

Withdrawing Consent 

Template for Withdrawal or Partial Withdrawal of Consent for Research - February 2016

Last modified: Feb 01, 2016
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