Appendix f: informed consent form, in-person survey (spanish) - cdc 2025

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Instructions for Developing an Informed Consent Document General Information. Describe the purpose(s) of this research study in lay terms. Purpose of the Study. Procedures. Risks. Benefits. Compensation, Costs and Reimbursement. Withdrawal or Termination from Study. Confidentiality.
I have read this form, been given the chance to ask questions and have my questions answered. If I have more questions, I have been told who to contact. By completing and returning the survey, I understand that I am agreeing to be in this study. I can keep a copy of this consent information for future reference.
General Guidance for Writing Consent Documents The procedures used in obtaining informed consent should be designed to educate potential study participants in terms that they can understand. Therefore, consent documents must be written in plain language with as few technical terms as possible.
Function The nature of the procedure or intervention. The risks and benefits of the procedure or intervention. Reasonable alternatives. The risks and benefits of alternatives. An assessment of the patients understanding of these elements [10][11]
Examples of giving verbal consent include: Yes That sounds great That feels awesome
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� Your individual responses will not be given to any third party whatsoever. � In addition, you will not be added to any mailing lists as a result of taking this survey. Only numerical results will be displayed. � Proceeding to the survey implies that you understand and agree to provisions in this disclaimer.
I have read and understand the information in this form. I have been encouraged to ask questions and all of my questions have been answered to my satisfaction. I have also been informed that I can withdraw from the study at any time. By signing this form, I voluntarily agree to participate in this study.
If survey is administered in-person, via email, U.S Mail, etc., include: I have read this form, been given the chance to ask questions and have my questions answered. If I have more questions, I have been told who to contact. By completing and returning the survey, I understand that I am agreeing to be in this study.

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