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Intake form

Please provide below information. This information will be used to evaluate if Health Innovation Netherlands can offer you the support you are looking for. All information provided is kept confidential, will not be used for any other purposes and will not be shared with any third parties.

Innovator name

Contact name

Contact e-mail

Contact phone

Product name

Brief product description (describe at least the intervention, target population and the setting,e.g. primary care, hospital care)

What is your primary claim? What is the health issue you’re trying to solve and what are the advantages of your innovation? Why is your innovation superior to alternatives?

Current (technical and clinical) status of the product, including target market entry. Briefly describe (clinical) studies conducted or planned.

What is/are your main question(s) to HI-NL?

Does a working prototype exist?

Yes

Has the product already received CE marking?

Yes

Where did you first hear about HI-NL / the HI-NL Track?

e.g. conference/event, LinkedIn, online search, grant application, webinar...