Non-Disclosure and Consent Form

Thank you for participating in our study. Please be aware that confidential information may be disclosed to you and that you must not reveal information that you learn during the course of your participation. In addition, audio and video recordings will be made of your session, to allow others who are not present to observe your session and benefit from your feedback.

Please read the statements below and sign where indicated. Thank you.

I agree that I will disclose no information about the study.

I understand that audio and video recordings will be made of my session. I grant permission for these recordings to be used for teaching and research purposes.

Test User
Place:
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Date:
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Name:
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Date of Birth:
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Signature:
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