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Examples of giving verbal consent include: Yes That sounds great That feels awesome
I (patient name) give permission for [practice name] to give me medical treatment. I allow [practice name] to file for insurance benefits to pay for the care I receive. I understand that: [practice name] will have to send my medical record information to my insurance company.
I agree to take part in [describe what involvement the individual will have e.g. an interview] and for the information I provide to be shared with the [area] Partnership agencies and this in turn allows services that I use to share information about me and my family for the purpose of this [research / activity].
Write the name of the research project here I have received, read and kept a copy of the information letter/plain language statement. I have had the opportunity to ask questions about this research and I have received satisfactory answers. I understand the general purposes, risks and methods of this research.
I, (name; please print clearly), have read the above information. I freely agree to participate in this study. I understand that I am free to refuse to answer any question and to withdraw from the study at any time. I understand that my responses will be kept anonymous.
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If you prefer to write your own consent document, you may do so, but be sure to include all required elements of informed consent.
Your participation in this study is voluntary. It is up to you to decide whether or not to take part in this study. If you decide to take part in this study, you will be asked to sign a consent form. After you sign the consent form, you are still free to withdraw at any time and without giving a reason.

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