My name is name from Organisation. We are collecting information about topic to purpose. The interview takes about 20 minutes.
- Taking part is voluntary. You may skip any question or stop at any time, with no effect on any service you receive.
- Your answers are confidential. Your name will not appear in any report.
- Data is stored securely and used only for this purpose.
Do you agree to take part? ☐ Yes ☐ No
Participant (or thumbprint)
Name, signature and date
Interviewer
Name, signature and date