Health Technology Assesment Request Form (old)

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:

Name of Approver

Email of Approver 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