Digital Health Policy Research Interview Consent
Please review the information below and provide your consent to participate in this research interview.
Participant Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Affiliation or Organization (if applicable)
Role or Position (e.g., healthcare provider, policy maker, researcher, etc.)
Please read the following information about the research interview:
You are invited to participate in a research interview about digital health policy. The purpose of this interview is to gather insights and perspectives on digital health policy development, implementation, and impact. Your participation is voluntary, and you may withdraw at any time without penalty. The information you provide will be kept confidential and used only for research purposes. No personally identifiable information will be shared outside the research team. There are no anticipated risks or direct benefits to you from participating. Your input is valuable and will contribute to a better understanding of digital health policy issues.
Do you consent to participate in this digital health policy research interview under the terms described above?
*
Yes, I consent to participate.
No, I do not consent to participate.
Do you agree to have your responses recorded (audio or written) for research purposes?
*
Yes, I agree to be recorded.
No, I do not agree to be recorded.
Do you have any questions or concerns about this research interview? (Optional)
Date of Consent
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please provide your signature to confirm your consent.
*
Submit Consent
Submit Consent
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