AGA Guideline Topic Submission Form

Thank you for your interest in submitting a guideline topic to the AGA Institute Clinical Guidelines Committee. For the committee to prioritize topics in a consistent manner, please provide the following information as completely as possible.

Question Title

* 1. Please provide your contact information in case the AGA Institute Clinical Guidelines Committee needs more information about your recommendations.

Name: *

Company: *

Address 1: *

Address 2:

City/Town: *

State/Province: *

ZIP/Postal Code: *

Country: *

Email Address: *

Phone Number: