Pharmaceutical Advertising Compliance Review Submission Form
Submission Date
Submitted By (Name)
Email
Department
Contact Number
Advertising Title / Name
Type of Promotion / Advertising
Print
Digital
Social Media
Broadcast
Other
Product Name(s)
Intended Audience
Healthcare Professionals
Patients
General Public
Distribution Channels
Proposed Publication/Release Date(s)
Ad/Promotional Materials (reference/ID number or list attachments)
Supporting References
Compliance Checklist / Issues to Note
Additional Comments