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Participant Consent Form

Hesta Health x Modality Postnatal Health Study

Please read this form carefully alongside your Participant Information Leaflet. Please read each statement below to confirm you have understood and agreed to that point, then sign at the bottom.

First Name

Last Name

Your date of birth

Email address

Phone number

GP Practice

I agree to be contacted to take part in Hesta Health user research (Optional)

Answering no to this question does not exclude you from taking part in the study.
I agree to be contacted to take part in Hesta Health user research (Optional)
A
B

Consent statements

I confirm that I have read and understood the Participant Information Leaflet (Version 1.0, March 2026) for the above study. I have had the opportunity to ask questions and have received satisfactory answers.

I confirm that I have read the Hesta Health Check Terms of Service and Privacy Policy.

I have had the opportunity to ask questions and have received satisfactory answers.


I confirm to be contacted for user research purposes throughout the study and understand that this will cease upon study end, unless I express a clear wish for otherwise.

I understand that my participation is entirely voluntary and that I am free to withdraw at any time (by contacting research@hesta.health), without giving a reason and without my medical care or relationship with my GP practice being affected in any way.

I understand that taking part in the study does not affect my usual access or communications to my GP.

I understand that if I withdraw from the study, data collected about me that has been anonymised may still be used unless I specifically request that it be deleted.

I consent to completing the Hesta360 digital health questionnaire which covers physical, emotional, and lifestyle health topics including some sensitive areas such as mental health and birth experience.

I consent to having a blood test as part of the study which will be carried out by a trained nurse or phlebotomist at my practice. I understand that my blood results will be passed from my practice to Hesta Health and I consent to this process.

I understand this involves a small needle prick and is a routine procedure.


I understand that if a clinical concern is identified following review of my Hesta360 responses or blood results, I may be contacted by the Hesta clinical team, and that my GP or practice may be notified if the concern requires urgent attention.

I agree to my personal data being collected, stored, and processed by Hesta Health for the purposes of this research study, in accordance with UK GDPR and NHS information governance standards.

I understand that my data will be kept securely, and will not be shared in a form that could identify me.


I understand that anonymised, aggregated findings from this study may be published in academic journals or presented at conferences, and that I will not be identifiable in any published outputs.

I agree to relevant sections of my medical records being accessed by the authorised Hesta research team and the HealthTech Implementation Fellow at my practice, where necessary for the purposes of the study.

I freely agree to take part in this research study.

By signing below, I confirm that I have had sufficient time and information to make a fully informed and voluntary decision to take part in this study, and I agree to all of the consent statements above.

Signature