Consent form for feedback




RESEARCH PARTICIPANT CONSENT FORM


Researcher’s name
Carl Graham
Title of research study
Human Computer Interaction – Personal Health Tracker
Module code
KV5003    
Module tutor’s name
and email address
Prof. David Kirk   
david.kirk@northumbria.ac.uk
Researcher’s Email
Carl.graham@northumbria.ac.uk

Brief description of nature of research and involvement of participant:
To go through the group’s personal health tracker and give feedback on what could be changed within the app and features that they may like.

Statement of participant* consent (please tick as appropriate)

I confirm that:
I have been briefed about this research project and its purpose and agree to participate*              
I have discussed any requirement for anonymity or confidentiality with the researcher                   
I understand that I have the right to withdraw from participation at any point                                
I agree to data collected about me being processed by the researcher                                         
I agree to be audio recorded, filmed or photographed

* Participants under 18 (or other ‘vulnerable populations’ cannot be involved in this research).

Information will be kept by the university for a period, and destroyed in accordance with university policy on the retention of data. No one will be able to access the information except our research group and university professionals.

Any additional concerns and requests from the participant:






Signed                                                                      Date                       


Standard statement by researcher

I have provided information about the research to the research participant and believe that he/she understands what is involved.

Researcher’s signature           ……………………………………….

Date                                         ……………………………………….


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