Initial Request to Get Access to the Patient Form

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This form served as my initial request to get access to the patient. Since my subject could not give her own consent, I consulted with her eldest daughter. First, I explained my reasons for my interest in her mother. Second, I explained the benefits of my intervention.

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Part 1: Consent Explanation

I am a nursing student doing a study on caring for Alzheimers patients. I wish to get involved in caring for a member of your family who is having dementia. My involvement is limited to social, medical and psychological support, meaning that I will be actively engaged in treatment of your family member.

The benefits of my intervention will be both to you and your patient. You will get a medical advice on caring for your patient as well as psychological support during this period. I will teach you how to give medicines and what danger signs to look for in the patient. Your patient will get five hours of my attention daily. He/she will get the best medicine and psychological counseling while required

Part 2: Seeking For Consent

I my desire to get medical and social support for my patient accept your request for participation in the patient care of my.. (Indicate family relation). I believe that the participation is intended to help the family and the patient in the care process.




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