Disclosure of Relevant Financial Relationships - Sample Form

Last Revised: 
Tuesday, October 26, 2010

The ACCME offers this document as a template for providers to use for obtaining financial relationship information. With modification it could be used for teachers, authors and members of planning committees.

Providers are NOT required or expected to use this form. ACCME is not recommending this document. The use of this document will not guarantee an ACCME finding of ‘Compliance’ for the Standards of Commercial SupportSM.