Consent Form
English Draft v0.1
Dialogical AI for Trauma Recovery Pilot Study
Study Title
Dialogical AI for Trauma Recovery: Exploring a Trauma-Informed Conversational AI Prototype
Consent to Participate
Please read each statement carefully and indicate whether you agree.
I confirm that:
☐ I am aged 18 or over.
☐ I have read and understood the Participant Information Sheet for this study.
☐ I understand the purpose of the research and what participation involves.
☐ I understand that participation is voluntary.
☐ I understand that I may pause or withdraw from the study at any time without giving a reason and without penalty.
☐ I understand that the chatbot used in this study is an experimental AI research prototype and is not a therapist, doctor, or crisis service.
☐ I understand that the chatbot may occasionally produce inaccurate, inappropriate, or emotionally unhelpful responses.
☐ I understand that discussing emotions, stress, or difficult experiences may cause temporary emotional discomfort.
☐ I understand that I should avoid sharing personally identifying information during chatbot conversations.
☐ I understand that anonymised or pseudonymised conversation transcripts and questionnaire responses may be analysed by the research team.
☐ I understand that anonymised excerpts from chatbot conversations may be used in academic publications, presentations, or future research outputs.
☐ I understand that if language suggesting immediate risk or crisis is detected, the chatbot may encourage me to seek human or emergency support.
☐ I have had the opportunity to ask questions about the study.
☐ I freely agree to participate in this research study.
Optional Consent
☐ I agree to be contacted for optional follow-up discussion, interview, or future related research opportunities.
☐ I agree to the use of anonymised quotations from my interaction for research or publication purposes.
Participant Name
Participant Signature
Date
Researcher
Dominic Sweeting
frontierpsychology@outlook.com