Phase 1 - Participant Consent Form

Phase 1 - Participant Consent Form

The Royal Women’s Hospital

Title	A vicarious trauma and burnout prevention approach: Group EMDR for Health Professionals
Short Title	Group EMDR for Health Professionals
Protocol Number	ERM#112139
Local Reference Number	2024.416
Project Sponsor	The Royal Women’s Hospital
Academic Partner	University of Melbourne
Chief Investigator Principal Investigator	Dr Elizabeth McLindon Professor Kelsey Hegarty
Associate Investigator(s)	Dr Jenny Dwyer Ms Amanda Morris
Location	The Royal Women's Hospital

Declaration by Participant*

I have read the Participant Information Sheet, or someone has read it to me in a language that I understand.I understand the purposes, procedures and risks of the research described in the project.I have had an opportunity to ask questions, and I am satisfied with the answers I have received.I freely agree to participate in this research project as described and understand that I am free to withdraw at any time during the project.I understand that I will be given a signed copy of this document to keep.
Participant Information
Participant's Name*

First NameLast Name
Participant's Signature*

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Date Signed*

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Date
Participant Information

Declaration - for participants unable to read the information and consent formSee Note for Guidance on Good Clinical Practice CPMP/ICH/135/95 Section 4.8.9. A legally acceptable representative may be a witness*.
Participant's Name*

First NameLast Name
Participant's Signature*

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Date Signed*

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Date
* Witness is not to the Investigator, a member of the study team or their delegate. Witness must be 18 years or older.
Declaration by Researcher†

I have given a verbal explanation of the research project; its procedures and risks and Ibelieve that the participant has understood that explanation.
Name of Research † (please print)*

First NameLast Name
Research Representative's Signature*

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Date Signed*

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Date
† An appropriately qualified member of the research team must provide the explanation of, and information concerning, the research project.

Note: All parties signing the consent section must date their own signature.
Please verify that you are human*
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Phase 1 - Participant Consent Form

Participant Information

Participant Information

Declaration by Researcher†