Alyson McCann, Department of Natural Resources Science
Laurel Schaider, Silent Spring Institute
Sources, Transport, Exposure and Effects of PFASs
Version date: 02-19-18

Consent Form for Research

Sources, Transport, Exposure and Effects of PFASs
Private Well Testing Program

Laurel Schaider
Research Scientist, Silent Spring Institute
(617) 332-4288 extension 224

Alyson McCann
Water Quality Program Coordinator, University of Rhode Island
(401) 874-5398

  • The purpose of the study is to test for per- and polyfluoroalkyl substances (PFASs) in private drinking water wells on Cape Cod. Our overall goal is to improve our understanding of the extent of PFAS exposure through private well water on Cape Cod, to identify potential sources, and to support private well testing and treatment to reduce PFAS exposure.
  • If you choose to participate, you will be asked to complete this consent form and a questionnaire about your private well. Completing both of these will take approximately 30 minutes of your time.
  • If your well is selected, we anticipate an additional two and a half hours for scheduling and conducting a home visit when members of our team collect water samples from your well.
  • Risks or discomforts from this research are minimal.
  • The benefit to people on Cape Cod and elsewhere is greater knowledge about patterns of groundwater contamination and factors that might help predict which wells are most vulnerable.
  • You will not be paid for you participation.
  • You will be provided a copy of this consent form.
  • Taking part in this research project is voluntary. You don’t have to participate and you can stop any time.


You are invited to take part in this research study. The information in this form is meant to help you decide whether or not to participate. If you have any questions, please ask.

Documentation of informed consent

You are voluntarily making a decision whether or not to be in this research study. Signing this form means that

  1. you have read and understood this consent form,
  2. you have had the consent form explained to you,
  3. you have had your questions answered and
  4. you have decided to be in the research study.
We will send you a copy of this consent form to keep.

Please complete the following information: