WikiJournal of Medicine/Submission letter for single author

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To submit an article where you are the sole author, please email this form to SubmissionsAt signWikiJMed.org

Dear WikiJournal of Medicine editors,

I hereby affirm that I, [NAME], am the author of [ARTICLE TITLE] which is [ATTACHED or AT THE FOLLOWING URL], and I request to have it published in WikiJournal of Medicine.
I agree to have this work published under the free license "Creative Commons Attribution-ShareAlike 3.0 Unported" (or comparable license).
I affirm that the article content is not already submitted to a publisher that prohibits further publication.
I acknowledge that I cannot withdraw this agreement, and that the content may or may not be kept permanently on a Wikimedia project.

I would like to recommend the following would be suitable peer reviewers for this work:

  • [UP TO 6 NAMES AND EMAILS FOR SUGGESTED REVIEWERS]

I also request the following not be considered peer reviewers for this work:

  • [UP TO 6 NAMES FOR EXCLUDED REVIEWERS]


Contact details:

[I agree to have my email address stated online in the work as corresponding author] (or alternatively)

[I have signed up to Wikipedia/Wikiversity under the username [USERNAME] and entered my email address] (email address can be kept private in user preferences, but readers can still correspond through the EmailUser function).


Conflicts of interest:

My institution [HAS / HAS NOT] at any time received payment or services from a third party for any aspect of the submitted work.

I [HAVE / DO NOT HAVE] financial relationships, regardless of amount of compensation, with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what I wrote in the submitted work. This includes all sources of revenue paid, or promised to be paid, directly to me or my institution on my behalf over the 36 months prior to submission of the work.

I [HAVE / DO NOT HAVE] patents, whether planned, pending or issued, broadly relevant to the work.

There [ARE / ARE NOT] other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what I wrote in the submitted work.

(Explain any additional potential conflicts of interest if present)


[NAME]
[INSTITUTION] (if applicable) (such as university or hospital)
[DATE]

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