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Submit a Treatment for Review

Complete the form below to submit an investigational treatment for review by the Montana Experimental Treatment Review Board. Please provide complete and accurate information to support the board's evaluation. Additional documentation may be requested during the review process.

Company Information:

Company Name

Representative Name

Email Address

Phone Number

Treatment Information:

Treatment Name

Indication

Clinical Trial Number

Clinical Trial Link

Administration Process:

How is the treatment administered?

Submission Declaration
By submitting this application, you confirm that the information provided is accurate to the best of your knowledge. The Montana Experimental Treatment Review Board may request additional information or documentation as part of its review. Submission of an application does not guarantee review or a favorable determination.