October 26, 2017

Idea Disclosure Form

The Purpose of the Confidentiality Agreement is to protect all participating parties and all related intellectual property.
The Purpose of completing and submitting the Idea Disclosure Form is to help us better understand your concept and invention in order to conduct an initial appraisal for you.
Before proceeding please read our Confidentiality Agreement here:
Please see a sample of a completed Idea Disclosure Form here:

*Indicates Requires field

Please indicate that you have read and agree with the terms of the above non disclosure agreement:*
AgreeDisagree


Are there any other parties, promoters, business partners involved?*
YesNo

Clinical Specialty of the idea: (Mark all that apply)*
AnaesthesiologyCancerCardiovascularChemistryDentalDermatologyEar, Nose, and ThroatEmergency MedicineGastroenterology and UrologyGeneral SurgeryHaematologyImmunologyMicrobiologyNeurologyObstetrics and GynaecologyOphthalmicOrthopaedicPathologyPaediatricsPhysical Medicine/RehabilitationRadiation MedicineRadiologyToxicology

Where and in what situation is it used?*
HospitalOperating RoomGP ClinicPrimary Care CentreAt Home

Is the solution?
Single-use (disposable)ReusableResponsible (partly disposable)