02.04.2013 Views

The psychopathology of everyday art: a quantitative Study - World ...

The psychopathology of everyday art: a quantitative Study - World ...

The psychopathology of everyday art: a quantitative Study - World ...

SHOW MORE
SHOW LESS

You also want an ePaper? Increase the reach of your titles

YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.

North Staffordshire Health Authority<br />

Research Ethics Committee<br />

PERSONAL CONSENT TO THE CONDUCT OF A RESEARCH<br />

INVESTIGATION<br />

STUDY TITLE Describing pictures by different groups <strong>of</strong> patients<br />

NAME OF CLINICIAN Dr. D. Foreman and Ms. S. Hacking<br />

<strong>The</strong> aims and procedures <strong>of</strong> the clinical investigation in which I have been asked to take<br />

p<strong>art</strong> have been explained to me by ward staff. I have read and understood the patient<br />

leaflet set out overleaf, and have been informed about the possible benefit to myself and<br />

about any foreseeable risks or discomfort.<br />

I have had the opportunity to ask questions and to consider the answers given.<br />

I understand that p<strong>art</strong>icipation in the study is voluntary and that I may withdraw from the<br />

study at any time <strong>of</strong> my own accord. If I do withdraw it will not affect the future care and<br />

attention which I will receive from my doctors.<br />

I agree that the relevant p<strong>art</strong>s <strong>of</strong> my medical records may be disclosed to Dr. Foreman<br />

provided they agree not to reveal my name.<br />

I hereby freely give my fully informed consent to taking p<strong>art</strong> in this clinical investigation.<br />

Name ……………………………….. Signature …………………………….<br />

Date ………………………………….<br />

I confirm that I have explained the nature <strong>of</strong> the above investigation to the above named<br />

patient.<br />

Name ……………………………….. Signature …………………………….<br />

Date ………………………………….<br />

413

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!