Reviewer form

Review of Speaker Financial Interests
Speaker/Faculty member you are reviewing*
Name of activity where they are presenting*
Date of Talk*

MonthDayYear
The reviewer form must be completed PRIOR to the date of the talk
Talk Title
Your Name*
Please select one of the below options and provide a brief explanation of your reasoning in making the determination.
On the basis of the information provided I have determined that:*

This individual’s financial interests ARE NOT related to the content of the activity.This individual’s financial interests ARE related to the content of the activity, but patient treatment options are not addressed in his/her presentation or instructional materials.This individual’s financial interests ARE related to the content of the activity and patient treatment options are discussed. I have reviewed the presentation/instructional materials and found them to be evidence-based and free of bias or advertising messages.
Comments*

Review of Speaker Financial Interests