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Attendee
Last name*
Job title*
Email*
First name*
Company Name*
Year founded*
Number of employees
Last Investment Round (please select one)*
Pre-Seed
Seed
Series A
Series B
Series C
Other
Size of last investment round
Date of last investment round
Is it your intention to set up a company in the UK in the future?*
If yes, would this be a subsidiary or would you move your Head Quarters to the UK?
Name of Product or Service?*
Which patient population does your innovation diagnose or treat?*
Which disease area(s) / clinical condition(s) does your innovation diagnose or treat?*
In which setting is your innovation/product used (e.g. hospital, primary care, community, home)?*
Hospital
Primary care
Community care
Domiciliary care
Home care
Other
Have you discussed your innovation with anyone from the UK National Health Service (NHS) previously?*
Yes
No
If yes, please name them & their institution(s).
Please describe your innovation/product in 250 words (In English please)*
Are you aware of the current standard of care in the UK? How does your product or service improve on this?*
How is your innovation likely to benefit the NHS or its patients (in English please)*
Have you generated any data/evidence that can be shared around your innovation?*
Yes
No
Which area does your product/innovation focus on? (tick all that apply)*
Pharmaceutical
Therapeutics (non-pharma)
Medical device (non-diagnostic e.g. implants)
Diagnostics
Digital health
Other
Does your product/innovation fall under any of the clinical area categories below? (tick all that apply)
Colorectal Surgery
Vascular Surgery
hepato-biliary surgery
Surgery
Neurosurgery
Woundcare
Long Term Neurological Conditions
Renal care
Diabetes care
Radiology
Emergency Medicine
Outpatients care
Oncology
Advanced therapies
Diagnostics and medtech evaluation
Digital pathology and AI
Electronic patient data
Phase 3 virtual trials
What technology readiness level (TRL) is your solution at? https://ec.europa.eu/research/participants/data/ref/h2020/wp/2014_2015/annexes/h2020-wp1415-annex-g-trl_en.pdf*
TRL 1 – basic principles observed
TRL 2 – technology concept formulated
TRL 3 – experimental proof of concept
TRL 4 – technology validated in lab
TRL 5 – technology validated in relevant environment (industrially relevant environment in the case of key enabling technologies)
TRL 6 – technology demonstrated in relevant environment (industrially relevant environment in the case of key enabling technologies)
TRL 7 – system prototype demonstration in operational environment
TRL 8 – system complete and qualified
TRL 9 – actual system proven in operational environment (competitive manufacturing in the case of key enabling technologies; or in space)
Does your product have regulatory approval, CE Status?*
Have
In process (within 12 months)
Planned (and notified body contacted)
Not currently planned
Not required
Other
Does your product have regulatory approval, FDA?*
Have
In process (within 12 months)
Planned
Not currently planned
Not required
Other
If yes please give details of classification and certification / device Instructions for Use (IFU)
What type of partnership are you seeking? (tick all that apply)*
Academic Design partner
Clinical Design Partner
Help with Intellectual Property
Help with regulatory approval
Clinical Evaluation including access to clinical trials
Brokering of discussion with NHS Organisations for adoption
Distributors
Investors
Other (please specify below)
If other, please specify
What would you like to get out of a partnership with one of our UK partner organisations?*
Funding to move projects forward (please tick those that apply)*
We have funding in place to move projects forward
We are currently seeking private investment to enable us to move projects forward
We would apply for public grant funding to move projects forward in the first instance
We would only be able to undertake a project if public grant funding was awarded
Please attach a one page outline of your innovation and copies of any relevant published papers.
Please provide the google document/drive links to any additional files or papers you'd like to submit:
Please attach a pitch slide deck.
Please confirm that you have read and agree to the 'Terms and Conditions - Privacy Statement' attached below.*
Yes - I confirm that I have read and agree to the privacy statement
No - I do not agree to the statement and therefore my application is not valid for this challenge
Terms and Conditions - Privacy Statement
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