Unlock hundreds more features
Save your Form to the Dashboard
View and Export Results
Use AI to Create Forms and Analyse Results

Sign UpLogin With Facebook
Sign UpLogin With Google

Case Study Consent Form Template

Ensure Ethical Research with Our Consent Form Template

Without a clear consent process, your research can face legal challenges and ethical dilemmas. This Case Study Consent Form Template is designed for researchers like you who need to obtain informed consent from clients or participants for your studies. Utilize this template to ensure clarity in your permissions, keep your research compliant, and protect client confidentiality, all while streamlining the consent process so you can focus on what really matters: your research success. Check out the live template to simplify your consent gathering!

Full name
Email address
Company or organization
Job title or role
Briefly describe your use case and outcomes you are comfortable sharing
I consent to participate in a case study
Yes
No
I grant permission to publish case study materials as described
Yes
No
Preferred attribution for publication
Full name, job title, and company
First name and company
Job title and company only
Company name only
Anonymized (no identifying details)
Media and materials I authorize you to collect and use
I would like to review and approve the final draft before publication
Yes
No
Retention period for my consent and materials
Until I withdraw consent
Up to 2 years
Up to 5 years
Single-use only (one publication/campaign)
Not sure
I am at least 18 years old and have legal capacity to consent
Yes
No
I am authorized to grant this consent on behalf of my organization (if applicable)
Yes
No
I understand I will not receive compensation unless agreed in writing
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I understand I can withdraw consent at any time with reasonable notice
Strongly disagree
Disagree
Neither
Agree
Strongly agree
Type your full legal name as your signature
Date of signature
{"name":"Full name", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"Full name, Email address, Company or organization","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
paper art illustration highlighting case study consent form template for FormCreatorAI article

When to use this form

Use this consent when you plan to publish or share a client or patient story for research, education, or outreach. It protects privacy, sets boundaries, and documents permissions to use quotes, images, and outcomes. Clinicians, therapists, researchers, and comms teams benefit, especially when preparing a case report or training material. Collect it before interviews, photos, recordings, or pulling data from health records. For mental health services, pair it with the Professional counselling informed consent form or the Psychotherapy informed consent form to cover treatment consent separately. If your story references workplace or clinical screening, also record permissions with a Drug test consent form. The result is clear, defensible consent that speeds reviews and builds trust.

Must Ask Case Study Consent Questions

  1. Do you consent to the collection, use, and publication of your information for this case study?

    This captures explicit, unambiguous permission and the legal basis for processing. It reduces disputes and ensures you proceed only when the person affirmatively agrees.

  2. How should we identify you (full name, initials, or anonymous)?

    Identity preference guides how you attribute quotes and images. It also sets your de-identification steps to prevent re-identification risk.

  3. Which types of information may we include (text, images, audio, video, and relevant records)?

    Scoping the content avoids oversharing and data creep. If the case includes treatment details, confirm those permissions separately, for example with an IV Therapy consent form.

  4. Where may we share your story (journal, website, social media, training materials, or internal report)?

    Specifying channels and audiences sets expectations and rights. It helps you tailor disclaimers and timelines for each outlet.

  5. Do you want to review and approve the final draft, and can you withdraw consent before publication?

    Stating review and withdrawal rights builds trust and clarifies your process. Set a clear cutoff date so you can meet deadlines without surprises.

More Forms

Copy/Edit Form Send to Recipients Make a Form w/AI Form Builder Must Ask Questions
  • 100% Free - No Catches
  • Collect Responses Today
  • Tailor to your Look & Feel