I, , have submitted for publication in the Surgical & Cosmetic Dermatology a manuscript entitled: I hereby certify that (1) the work reported in this manuscript has not received any financial support from any pharmaceutical company or other commercial source, except as described below, and (2) neither I nor any first degree relative has any financial interest in the subject matter discussed in the manuscript.

Please indicate on the grid below the type and nature of any relationships you and your first degree relatives have had in the past five years with any private company or nonprofit organization.