Research Consent Form

Research Consent Form
Gastrology Research

Gabriella Morales

Introduction - This research will focus on the study of the digestive system, more specifically the Stomach. During the research we will fund the participants all the supplies needed in order for participants to be able to perform a self endoscopy in order to see the stomach/ Digestive system. Participants will be doing this at home.

Purpose of Research - The purpose of this research is to identify the number of participants who are willing to help research gastrology at home. The research aims to find more about the human stomach and how different it is depending on the countries/ genders/ diets, and we will be helping gastrologists with the footage we collect from the participants. The Footage we collect will be used to help research the fight against cancer and other diseases.

Duration - This research might be completed within 3 years. Provided that all participants will be available on the scheduled dates.

Benefits - In this research, the benefits will be explained in detail for both the participants and the researcher. Examples will be given and different use cases. Some participants may get payed depending on agreements.

Confidentiality - The data provided by the participant will be considered strictly confidential and will not be given to others without written permission from the participant.

Right to Refuse or Discontinue - The participant has the right to discontinue or decline the participation in the research anytime he/she feels to do so.
The Participants acknowledge

I confirm that my participation in this research project is voluntary unless payed.I acknowledge that I will not be receiving any payments in regard to my participation unless agreements are made to be paid during participation.I confirm that the duration of the research where I will participate may last up to 3 years. which includes recorded interviews and completing surveys. Participants don’t have to stay for the full 3 years.I acknowledge that I have the right to decline or discontinue my participation in this research when I have a valid reason to do so.I have read and understood what the research is all about and how it will affect the target audience.I understand that the researchers will not identify me by name in any reports using information captured from one of my interviews or answers to the surveys I completed.I understand that the researchers will publish their materials in books, videos, newspapers, magazines, and other research-related projects.I understand the risks that may happen during the research and I the participant aren’t able to sue for any damages that may happen.I understand that any money given from the researchers to fund the research will be only used for the materials needed for the research unless further agreements are made.I understand that the research will be safe and if any accidents happen, the researchers will have no responsibility towards the damages.
Participant Information
Participant's Name

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Gender

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Phone Number (Optional)
Email
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Participant's Signature

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Research Representative
Name of Individual taking the consent

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Gabriellas Gastroendoscpy Research Group
StomachResearchEndo@gmail.com
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Research Consent Form

Participant Information

Research Representative