1 Start 2 Complete Disclosure of financial relationships with commercial interests: (The ACCME defines a "commercial interest" as any entity producing, marketing, re-selling, or distributing health care goods or services, used on, or consumed by, patients. The ACCME does not consider providers of clinical service directly to patients to be commercial interests. For more information, visit www.accme.org.) First Name * Last Name * Credentials * DO MD Other... Credentials Other... E-mail * Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20202021202220232024 Please select the journal for which you are completing a manuscript review: * Clinical Imaging American Heart Journal American Journal of Ophthalmology Journal of Shoulder and Elbow Surgery Please select the statement that best describes you: * I declare that I or my spouse/partner do not/does not have a financial relationship with any commercial interest. I declare that I or my spouse/partner do/does have a financial relationship with any commercial interest within the last 12 months. (Please specify below.) Commercial Interest * Disclosures should include relationships in any amount. MyselfPartnerN/A Speakers Bureau Speakers Bureau - Myself Speakers Bureau - Partner Speakers Bureau - N/A Consultant, advisor Consultant, advisor - Myself Consultant, advisor - Partner Consultant, advisor - N/A Stock Ownership Stock Ownership - Myself Stock Ownership - Partner Stock Ownership - N/A Research Grant Research Grant - Myself Research Grant - Partner Research Grant - N/A Employment Affiliation Employment Affiliation - Myself Employment Affiliation - Partner Employment Affiliation - N/A Royalties, patents Royalties, patents - Myself Royalties, patents - Partner Royalties, patents - N/A Name of Commercial Interest Entity (*n/a if none) * Leave this field blank