Samples of Certificate
1. Purpose of research and benefits :
We are studying the
Briefly explain what you wish to gain from the study in very easy/comprehensible language.
In simple and comprehensible language explain the benefit of your study in future.
2. Possible risks:
Explain what are the potential risks associated with patient participation in your study.
3. Study procedures:
Briefly explain the procedure followed in your study.
4. Confidentiality:Your medical records will be treated with utmost confidentiality.
The results of this study would be published in a scientific journal/thesis but you will not
be identified by name.
5. Your participation and rights :Your participation in this study is absolutely
voluntary and you may withdraw from the study any time, without having to give reasons for the same.
In any case, you will receive appropriate treatment for your condition at ,.
Signature of consenting Patient Signature of WitnessDate: