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Consent Form For Research Participants:

1. By clicking “next” below, I am agreeing to participate in a study of couple relationships. I understand that I will be asked to answer a number of questions related to this topic, and that answering the survey questions will take approximately 45-60 minutes.

2. I accept the invitation from the Primary Researcher, Robert Green, a professor at the California School of Professional Psychology at Alliant International University, San Francisco campus to complete an online survey that asks questions about my couple relationship, my general mood over the last week, the support I feel from friends and family members, my approach to social situations, and basic information about my age, sex, race/ethnicity, education, sexual orientation identity, and type of couple legal relationship if any (such as being married or in a domestic partnership).

3. I am participating in this research because I want to and not because anybody forced me.

4. I understand that this study poses no physical risk and only minimal risk of psychological stress or harm. I also understand that if, during or after my participation, I experience any undue anxiety or stress related to my participation, I will be provided with the name and telephone number of a licensed counselor who will be available by phone to discuss my reactions to the study. If I desire further consultation, this counselor will provide me with a geographically appropriate referral for follow-up treatment. The initial phone consultation will be provided at no cost to me. I would be responsible for covering the costs of any treatment beyond the initial phone consultation.

5. I understand that I may refuse to answer any question at any time. I understand that I may stop my participation at any time. If I give my contact information at the end of the survey, I also would be able to withdraw information I provided at any time. However, if I do not provide contact information at the end of the survey, it would be impossible to withdraw my data later because the researchers would not know which set of anonymous responses belonged to me.

6. Benefits: I understand that my participation may add to an understanding of couple relationships. If I request and provide my contact information, a summary of the results of this research will be sent to me upon completion of the work. The summary will contain information about the whole group of participants, and my individual results will not be contained in the summary nor available to me or to anyone other than the researchers.

7. I understand that all information gathered in this study will be held confidential. Special steps will be taken by the researchers to protect my confidentiality due to the sensitive and personal nature of some of the material contained in the questionnaires. All information will be stored in electronic form on compact discs and kept in locked filing cabinets. After I’ve completed the survey, my name and all other identifying information (if I choose to give it) will be stored separately from my questionnaire responses in order to preserve confidentiality.

“Confidentiality” means here that only the researchers directly involved with the project will have access to information that can link, via a code number, my identifying information to my answers. I understand that this linking information is only necessary because of the researchers’ intentions to perform follow-up studies in which I can either choose or decline to participate. I understand that my questionnaires will be shredded five years after the completion of the project or publication (whichever comes later), unless I give my consent to the researchers to retain my questionnaires for further follow-up studies.

8. I understand that there are the following limits to the confidentiality described in item #7 above. If, during the course of this study, I reveal evidence of past or present child abuse, reveal evidence of abuse to elders or dependent adults, or reveal an intention to cause immediate harm either to myself or to someone else, the researchers will be required by law to report this to the appropriate authorities. All information not subject to these limitations will remain completely confidential.

9. I understand that the Primary Researcher, Robert Green, will be available to me by telephone 415-955-2115 or e-mail ( to answer any questions or to address any comments or concerns that I have about the study before or after participation. If I have further concerns, I may also contact the Institutional Review Board of Alliant International University – San Francisco Campus by electronic mail (

10. I certify that I am least 18 years old, have been a partner or spouse in a couple relationship for at least one year, am a resident of the U.S. or Canada, and that I understand the purposes and procedures of this study. By clicking “NEXT”’ below, I am giving my full consent to participate in this study.

Before clicking NEXT below, you can print out a copy of this Consent Form to keep in your own files, in the same way you usually would print any document that you had on your computer screen.