Consent for Data Collection

Consent for Data Collection

This form is for participation in a brief research study testing glasses for eye movement data collection.
Name

First NameLast Name
Email
example@example.com
Phone Number

Country CodeArea CodePhone Number
WhatsApp Number

Country CodeArea CodePhone Number
Sex
Date of Birth
Month
Day
Year
Ethnicity
Any history of seizures? Note: If you answered yes, please refrain from participating.
Signature
Do you wish to participate?
Should be Empty:

Date of Birth