Confidentiality form Patricia Reiners | @ ux.

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Confidentiality Form
All designers conducting research are encouraged to use a confidentiality form to protect participants and yourself
in the unlikely case of a dispute regarding your research. Prior to each interview, walk through the form with parti-
cipants to ensure they are comfortable and kindly request a signature. Offer to share a copy with the participant(s)
following the study.

Key Sections

1. Why we record sessions

...allows me to take minimal notes and focus on the discussion with you
...allows me to refer to our conversation at a later date and share the observation with
project team members

2. Ensuring your privacy

… I will not to disclose any confidential information that you provide to us without
your permission
… I reserve the right not to answer any of the questions asked or not to complete any
of the research activities requested.

3. Your participation in this study is voluntary

… I will not to disclose any confidential information that you provide to us without … I
have read and understood the statements of this form.
... I voluntarily agree to participate in this study

4. Signature, date etc.

Researcher(s) Name, Signature, Date
Participant(s) Name, Signature, Date

Researcher Name, Date Participant Name, Date