All of my questions have been answered to my satisfaction. If I decide later that I would like to withdraw my consent from the data collection, I can do so at any time, without impacting on my participation in the main study. partner’s I voluntarily agree to participate in this data collection study. I will be given a copy of this signed Pregnant Partner Data Release Consent Form. _____________________________ ____________________________ _________________ Pregnant Name Pregnant Signature Date Partner’s Printed Partner’s Investigator or Delegate Statement I have carefully explained this data release form to the pregnancy partner named above. To the best of my knowledge, she understands the nature, demands, risks and benefits involved in taking part in this data collection. _____________________________ ____________________________ _________________ Printed Name Date Investigator/Delegate’s Investigator/Delegate’s Signature
All of my questions have been answered to my satisfaction. If I decide later that I would like to withdraw my consent from the data collection, I can do so at any time, without impacting on my partner’s participation in the main study. I voluntarily agree to participate in this data collection study. I will be given a copy of this signed Pregnant Partner Data Release Consent Form. _____________________________ ____________________________ _________________ Pregnant Partner’s Printed Name Pregnant Partner’s Signature Date Investigator or Delegate Statement I have carefully explained this data release form to the pregnancy partner named above. To the best of my knowledge, she understands the nature, demands, risks and benefits involved in taking part in this data collection. _____________________________ ____________________________ _________________ Investigator/Delegate’s Printed Name Investigator/Delegate’s Signature Date
Pregnant%20Partner%20Data%20Release%20Form%20Template%20Final,%20February%2026,%202014.docx