It is the policy of the Wisconsin Medical Journal to ensure balance, independence, objectivity, and scientific rigor in the Journal. All authors are required to disclose to the readers any real or apparent conflict(s) of interest that may have a direct bearing on the subject matter or content of the article. This pertains to relationships with pharmaceutical companies, biomedical device manufacturers or any other corporations or organizations whose products, services, or functions may be related to the subject matter of the article. The intent of the policy is not to prevent authors with a potential conflict of interest from publication. It is merely intended that any potential conflict should be identified openly so that the readers may form their own judgments about the article with the full disclosure of the facts. It is for the readers to determine whether the author’s outside interests may reflect a possible bias in either the article’s exposition or the conclusions presented.

Click here for the printable version of the form: The Author Disclosure Declaration requires the following information from all authors.

Title of the Article

Author/Co-authors Names

Grant/Research Support
I have a financial interest and/or other affiliation or arrangement with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject or content of this article.

Affiliation/Financial Interest Name of Organization(s)

• Consultant
• Speakers Bureau
• Employee
• Major Stock Shareholder

(1000 shares or more)
• Other Financial or Material Support
• Other Affiliations

Please include this form with your initial submission to the Wisconsin Medical Journal at PO Box 1109, Madison, Wisconsin 53701.