Conflict of Interest Form

Manuscript ID:

Manuscript title:

Corresponding author’s name:

Examples of conflicts of interest include the following: source of funding, paid consultant to sponsor, study investigator funded by sponsor, employee of sponsor, board membership with sponsor, stockholder for mentioned product, any financial relationship to competitors of mentioned product, and others (please specify).

I accept the responsibility for the completion of this document and attest to its validity on behalf of all co-authors.