Study # __________ Incentive: ______
Group: ___________ Time: __________ Date:__________
BANYAN COMMUNICATIONS CONSENT FORM
Please read and sign this sheet before you attend the focus group
We’re pleased you have accepted our invitation to participate.
You will be responding to topics of interest to the Centers for Disease Control and Prevention (CDC). CDC engaged us to recruit for their discussion. The entire focus group will be:
Observed (sight and sound) virtually via virtual meeting platform. Observers may include CDC staff and our staff.
Recorded (audio and video). The audio recording will be the property of CDC. CDC will protect your privacy and confidentiality, and none of your personally identifiable information will be released.
In return for your voluntary participation in this project, we will provide a $75 gift card to you for your time spent during the focus group.
Since
your opinions, observations, reactions, and other expressions are the
reason for conducting this focus group, we hope you will participate
fully in the process. The
risks of participating in the focus group will be minimal. You do not
have to respond to any questions you don’t want to answer.
By signing this document, you acknowledge that you understand, agree to, and consent to the above.
_______________________________
Sign
_______________________________
Print Name
_______________________________
Date
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Jacobi, Amy (CDC/NCEZID/DFWED/WDPB) |
| File Modified | 0000-00-00 |
| File Created | 2025-05-18 |