7/25/2019 Consent Formdocx

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1.0 Study title:

Health Anxiety Among Medical Students

2.0 Introduction :

We are Year 2 students from i!M Sg "uloh. We are interested to #no$ the health anxiety le%el

among medical students and their association &et$een gender and years of study. We are re'uesting

your (artici(ation to com(lete the 'uestionaire. Your coo(eration is sincerely a((reciated.

).0 *onsent form:

+escri(tion of the research and your (atici(ation

You are in%ited to (artici(ate in a research study conducted &y Year 2 medical students of i!M Sg

"uloh. !he (ur(ose of this research is to determine the health anxiety le%el and their association $ith

gender and years of study. Your (artici(ation $ill in%ol%e you to com(lete the 'uestionaire that has

 &een (ro%ided.

,rotection of confidentiality

!he confidentiality of records identifying the (artici(ant $ill &e maintained. Your identitiy $ill not &e

re%ealed in any (u&lication resulting from this study

*ontact information

If you ha%e any 'uestions or concerns a&out this tudy or if any (ro&lems arise- (lease contact

Muhammad Amirul "in A.M asir at 01)/03 and su(er%isor +r 4ffat 5mar at 01236)226 and

+r Aimi adira at 01)6)016/.

*onsent

I ha%e read this concent form and ha%e &een gi%en the o((ortunity to as# 'uestions. I gi%e my consent

to (artici(ate in this study.

,artici(ant7s signature: 8888888888888888888 date: 8888888888888 

,ersonal details:

9ender: ;M

Age <years=:

Years of study medicine: