Scribd
Upload
3 views

Client Protocol

Uploaded by

chiminiepabo11
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
3 views

Client Protocol

Uploaded by

chiminiepabo11
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

Kyla P.

Memije, RPm, RPsy, MA


Psychometrician
Polytechnic University of the Philippines
[email protected]
July 11, 2023

Gabrielle Gerodias
Santa Rosa, Laguna

Informed Consent for Participation in Psychological Assessment

Dear Gabrielle Gerodias,

I am writing to seek your voluntary participation in a psychological assessment that is required


for compliance to a university requirement. The purpose of this letter is to provide you with
detailed information about the assessment process and to obtain your informed consent for your
participation. Please read this document carefully, and feel free to ask any questions before
making your decision.

Purpose of the Assessment: The purpose of the psychological assessments (Sack’s Sentence
Completion Test, House-Tree-Person Test, and Purdue Non-Language Test) are to evaluate
various aspects your psychological functioning. These assessments are a mandatory requirement
set forth by Polytechnic University of the Philippines for the course Psychological Assessment.
The results of these assessments will be used solely for compliance purposes and will not impact
your academic standing or eligibility to participate in the university program.

Confidentiality: Your privacy and confidentiality are of utmost importance to us. All
information collected during the assessment will be kept strictly confidential and will be
accessible only to authorized personnel involved in the assessment process. Your personal
information, assessment data, and any other related materials will be securely stored, and your
identity will be anonymized in any reports or publications that may result from the assessment.

Voluntary Participation and Withdrawal: Participation in the psychological assessment is


entirely voluntary. You have the right to decline to participate, and your decision will not result
in any negative consequences for your relationship with Polytechnic University in the
Philippines or any affiliated parties. If you choose to participate, you may withdraw your consent
and discontinue the assessment process at any time without any repercussions.

Assessment Procedure: The assessment will involve a series of standardized tests, interviews,
and questionnaires that will help us understand various aspects of your psychological
functioning. The duration of the assessment may vary based on individual factors, but we
anticipate that it will take approximately 30 minutes to complete.
Potential Risks and Benefits: The psychological assessment is designed to be non-invasive and
is not expected to cause any physical harm. Some individuals may find certain questions or tasks
mildly distressing, but you are free to skip any part of the assessment that makes you
uncomfortable. While there are no direct benefits from participating in the assessment, your
cooperation will help you fulfill the university requirement and contribute to ongoing research in
the field of psychology.

Use of Assessment Results: As mentioned earlier, the assessment results will be utilized solely
for compliance with the university requirement. They will not be used for any other purposes,
and your academic performance will not be affected by the assessment outcomes.

Contact Information: If you have any questions, concerns, or wish to withdraw your consent at
any time during or after the assessment, please do not hesitate to contact me at 0931-797-1396 or
[email protected]. By signing below, you indicate that you have read and understood the
contents of this informed consent letter and that you voluntarily agree to participate in the
psychological assessment for compliance with the university requirement.

Gabrielle Gerodias
July 11, 2023

You might also like