Page 272 - PhD GT

Consent form - main study
CONSENT FORM
Signed..............................
Name..............................
Date...............................
Appendix 18
Consent form - reliability study
Appendix 17
In order to evaluate the effectiveness of the treatment you receive at the Unit, we will need to contact you after three months and then again after twelve months in order to repeat the questionnaires we have given you today.
We would be most grateful if you would give your consent for us to contact you for this purpose.
All the information you give us will be treated in the strictest confidence.
In the event that you have moved to a different address by the time we need to follow you up, we would be grateful if you could supply us with the name and address of someone with whom you are likely to keep in touch. Any contact we make with them will be strictly about your whereabouts and nothing else.
I give my consent for................................................................... Of (address).................................................................................
To provide information regarding my whereabouts so that I can participate in the follow-up to this study.
CONSENT FORM
We are currently looking at the usefulness of the questionnaires which we ask you to complete when you come to the Addiction Unit.
We are very grateful to you for agreeing to take part in this study by completing these 267