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Conflicts of interest disclosure form

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For authors

Title of the Article:

All authors are responsible for recognizing any conflict of interest that could bias their work in the acknowledgments, disclosing all financial support and any other personal connections.

Please check the appropriate box below:

  • 􀂆 No author of this paper has a conflict of interest, including specific financial interests, relationships, and/or affiliations relevant to the subject matter or materials included in this manuscript. OR
  • 􀂆 The authors certify that all conflicts of interest, as applicable to each author, including specific financial interests, relationships, and/or affiliations relevant to the subject matter or materials are disclosed in the manuscript.

(Please describe in detail about these interests.)

These interests may include one or more of the following: employment; consultancy within the past two years; ownership interests – including stock options – in a start-up company, the stock of which is not publicly traded; ownership interest - including stock options but excluding indirect investments through mutual funds and the like - in a publicly traded company; research funding; honoraria directly received from an entity; paid expert testimony within the past two years; any other financial relationship (e.g., receiving royalties); membership on another entity’s Board of Directors or its advisory committees (whether for profit or not for profit).


  • 􀂆 All authors certify that the work followed the research ethics and have approved the submission of the manuscript for publication.

Author’s name & signature         Date Author’s name & signature         Date
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Author’s name & signature         Date Author’s name & signature         Date
Author’s name & signature         Date Author’s name & signature         Date
Author’s name & signature         Date Author’s name & signature         Date


PIM : Perspectives on Integrative Medicine