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Health Technology Assesment Request Form

Important Information

This form is to be completed by the person requesting an evaluation of a new health intervention or technology or re-evaluation of an existing practice. Providing as much detail as possible will enable TAU to complete a balanced and expeditious evaluation.

1. Are the relevant Department and Divisional Heads aware and in support of this request for an evaluation? *This question is required.
Please provide the name and email of the person who approved the request:
A PDF of this completed request form will be emailed to the Approver This question requires a valid email address.
Please obtain approval from the relevant heads before continuing with this request