All authors of papers submitted to (name of journal) must complete this form and disclose any real or perceived conflict of interest.

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1 Disclosure of potential conflicts of interest Authors must disclose all relationships or interests that could have direct or potential influence or impart bias on the work. Although an author may not feel there is any conflict, disclosure of all relationships and interests provides a more complete and transparent process, leading to an accurate and objective assessment of the work. Awareness of a real or perceived conflicts of interest is a perspective to which the readers are entitled. This is not meant to imply that a financial relationship with an organization that sponsored the research or compensation received for consultancy work is inappropriate. All authors of papers submitted to (name of journal) must complete this form and disclose any real or perceived conflict of interest. Please complete one form per author. The corresponding author collects the conflict of interest disclosure forms from all authors. The corresponding author will include a summary statement in the text of the manuscript in a separate section before the reference list, that reflects what is recorded in the potential conflict of interest disclosure form(s). Please note that you cannot save the form once completed. Kindly print upon completion, sign, and scan to keep a copy for your files. The corresponding author should be prepared to send potential conflict of interest disclosure form if requested during peer review or after publication on behalf of all authors (if applicable). I have no potential conflict of interest. The form below is adapted from the International Committee of Medical Journal Editors Form for Disclosure of Potential Conflicts of Interest.

2 1. Interests directly related to the work under consideration This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking nothing to disclose means that you did the work without receiving any financial support from any third party that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation, or commercial sponsor, then complete the boxes to indicate the type of support and whether the payment went to you, or to your institute, or both. For examples of potential conflicts of interests that are directly related to the research please visit: springer.com/gp/authors editors/journal author/journal author helpdesk/before you start

3 2. Interests indirectly related to the work under consideration This section asks about your financial relationships with entities in the (bio medical) arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work s sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so. For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations, or academic institutions, need not be disclosed here (but can be acknowledged in the acknowledgement section). For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company. For examples of potential conflicts of interests that are indirectly related to the research please visit: springer.com/gp/authors editors/journal author/journal author helpdesk/before you start

4 3. Other interests Interests that go beyond financial interests and compensation (non financial interests) that may be important to readers should be disclosed. These may include but are not limited to personal relationships or competing interests directly or indirectly tied to this research, or professional interests or personal beliefs that may influence your research. Manuscript title Manuscript no. (if you know it) Author name Are you the corresponding author? Yes No Herewith I confirm that the information provided is true, accurate and complete. Author signature Date

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