Informed Consent Form
Clinical Performance Evaluation · Device Registration
Study: Clinical Performance Evaluation of Non-Invasive Hemoglobin and Glucose Screening Device, IIT Kharagpur.
The medical team has thoroughly explained the study procedures and purpose. Participation is entirely voluntary and the patient may withdraw at any time.
The medical team has thoroughly explained the study procedures and purpose. Participation is entirely voluntary and the patient may withdraw at any time.
Study Identifiers
Patient Details
Informed Consent Declarations
Patient must read and confirm each declaration by checking the box.
Patient Signature
Sign below using a finger or stylus on a touchscreen/touchpad.
Consent Taken By (Staff)
Health Camp Feedback
Post-visit patient feedback · Live display enabled
Patient Identification
Screening Experience Ratings
Rate each aspect on a scale of 1 to 5. All questions are required.
On a scale of 1–5, how satisfied are you with the health screening process? *
Dissatisfied
Satisfied
Were the steps of the screening process clearly explained to you? *
Unclear
Clear
Did you feel comfortable and your privacy was respected during the screening? *
Uncomfortable
Comfortable
Do you feel this screening helped you understand your health better? *
No
Yes
Additional Comments
Patient Records
All registered patients at Thrive Camp
0
Total Patients
0
Male
0
Female
0
Registered Today
| # | Setu ID | Patient ID | Name | Age | Gender | Device | Date |
|---|
No patients registered yet. Fill in a consent form to get started.
Display Screen
Mirror this on the secondary monitor — updates live as feedback is entered
Setu ID
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Patient ID
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Overall Experience
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Staff Helpfulness
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Written Feedback
What went well
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Suggestions for improvement
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