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Company engagement form v2

  • Please use this form to help us to understand your innovation, and your progress to date. Please note it is a generic form for innovations of all types and all stages of development. Please feel free to leave blank any questions that are not applicable to you at this stage
  • Please do not disclose any unprotected intellectual property via this form
  • Data from this form will be used to assess whether, and how, we are able to support you
  • Your information may be shared across the AHSN network
  • We will not share your information with other innovators or companies
  • You do not need to complete this form twice. If you’ve already completed it for any other AHSN please just share a copy with enterprise@uclpartners.com

Company engagement form (old version)

  • Please complete one form per innovation.
  • Intended purpose, functionality (what it does), clinical setting and the opportunity (size of intended patient group)
  • Please reference specific priority(s) in your answer
  • How is your innovation different to existing technologies/ products/ services?
  • Include references to market research you have undertaken to indicate target customer and the value of your technology to them, as well any sales achieved in one or more region to date.
  • Include cost vs affordability analysis, your budget impact model and any current gaps you believe you may have in your evidence.
  • Indicate how predictable your revenue is based on your existing model and whether your working capital extends beyond the next 12-18 months.
  • E.g. reduce journeys, consumable use, improved recycling, decarbonised supply-chain etc? If so, please tell us briefly or mark as not applicable:
  • For more information about our privacy practices please visit our privacy policy.

  • Please tick the “I’m not a robot” box below. This helps us to prevent automated submissions.
  • This field is for validation purposes and should be left unchanged.