Autism Research Consent Form
Please complete this form to provide participant information, indicate eligibility details, review the consent acknowledgment, and share any notes or contact preferences for the autism research study.
Participant Information
Participant Full Name
*
First Name
Middle Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Eligibility and Research Details
Participant age
*
Relationship to participant (if completing for someone else)
Can the participant understand and voluntarily agree to participate?
*
Yes
No
Unsure
Consent and Study Acknowledgment
Participant Signature
*
Additional Notes and Contact Preferences
Additional Notes
Preferred Contact Method
Email
Phone call
Text message
Postal mail
No contact
Submit
Submit
Should be Empty: