WP E-Signature by Approve Me - Sign Documents Using WordPress -

Taking Part in Ipsos Research Interview

Project name: DHSC Research about gambling
Location: Online via Microsoft Teams / Zoom
Dates:
If you have any questions, you can contact: Matthew Holdsworth ([email protected]).

This form asks if you are happy to take part in the research. Please read this form and the information sheet that comes with it carefully.

If you are happy with what it tells you about taking part in the research, please complete the form and return it to the recruitment agency.

Please write your initials by each statement in the box to the right to show that you agree.

I understand that I do not have to take part and that I can withdraw from the study at any time, and I do not have to provide a reason. I understand that I am under no obligation to share my personal experiences.

I am willing to:

• Take part in an interview either in person on Zoom / Microsoft Teams or face-to-face. This will involve a one-to-one discussion with an Ipsos researcher.

I understand that:

• The online interview will be audio recorded for note-taking purposes. In line with MRS Code of Conduct, the recording and transcript will be stored on our secure servers and no one outside of the Ipsos research team will have access to this.

• Ipsos will use Large Language Models (Artificial Intelligence) within a secure Ipsos dedicated environment to produce transcripts (text versions of the audio recordings of the group discussion).

I have received a copy of the project privacy notice and I understand that data concerning me will be stored and accessed in accordance with current laws, such as the UK General Data Protection Regulations (UK GDPR).

I understand that anything I say will not be linked to any information that can identify me (such as my name or contact information), following the rules of the 2018 UK General Data Protection Regulation (UK GDPR), unless one or more of the following apply:

• I discuss undisclosed illegal acts (this means offences that no one else knows about) that indicates that someone is at risk of harm.

• I discuss behaviour that is harmful to myself or someone else. I understand that any concerns would be discussed with me before anyone else was informed.

I understand that Ipsos will write a report summarising the research findings from the interview I have taken part in. Findings will be reported in aggregate (with everyone’s answers considered together) but the report may include specific quotations from my discussion which have been anonymised. The report will not be shared outside of these organisations or published in any way (e.g. will not be placed on online forums).

I agree to treat all information related to this research as confidential and will not disclose any information to any third party or use the information for my own purposes. (If this agreement is broken, the client and this sponsoring facility reserve the right to explore any legal means of redress within their rights).

If you have any questions, you can contact:
Project Manager Name: Matthew Holdsworth Email: [email protected]

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Draw Signature
Type In Signature

Draw your signature with your mouse, tablet or smartphone Clear

I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Adopt & Sign

Timestamp

Audit

September 15, 2026 2:53 pm BST

Taking Part in Ipsos Research Interview Uploaded by Frances Thomas-Gregory - [email protected] IP 82.16.202.177

September 15, 2026 2:57 pm BST

Frances Thomas-Gregory - [email protected] added by Frances Thomas-Gregory - [email protected] as a CC'd Recipient Ip: 82.16.202.177

September 15, 2026 2:59 pm BST

Frances Thomas-Gregory - [email protected] added by Frances Thomas-Gregory - [email protected] as a CC'd Recipient Ip: 82.16.202.177