Applicants Name
*
First Name
Last Name
Applicants Email
*
example@example.com
Applicants Phone Number
*
-
Area Code
Phone Number
Company Name
*
Company Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company Website
Short description of the business (up to 3 sentences).
*
If you have demo/prototype, you can provide the URL below remember to provide a username and password if necessary to access the information.
What is the legal structure of your business?
*
C Corp, S Corp, LLC, Etc.
Who are the founders of your company? (Name of each individual, time spent with company and number of years in the industry)
*
What problem is your company solving?
*
What is your approach to strategically solving the problem?
*
Is your product or service market ready?
*
Yes
No
My product or service will:
*
Have some novelty value (i.e., there is only minor demand for the product in the marketplace)
Make life a bit easier or more enjoyable for many people but not solve any fundamental problems (i.e., a "nice to have" but not a must have for most buyers)
Help a lot of people or companies do what they do a bit better, faster, and cheaper (i.e., the product addresses a fairly substantial need in the marketplace)
Save lots of lives and/or money (i.e., the product is urgently needed in the marketplace)
Is there intellectual property associate with your company?
*
Yes
No
Who owns the intellectual property associated with your company? Provide patent #(s) if applicable (elaborate if needed)
From an FDA regulatory standpoint, how would you classify your medical innovation?
*
Will a clinical trial be needed in the future?
*
Yes
No
If yes, provide an estimated time frame.
List names and websites for 3-5 of your competitors. (Can include a brief description)
*
If a Fortune 500 company decided to put their resources behind competing with my startup tomorrow, my startup would be:
*
Toast
Happy that the market is being validated by a major player, but would have to settle for a smaller market share
Able to stay a step ahead through innovation, agility, and speed
Delighted to partner with them and license our proprietary technology to them, since there's no way they can get in this market without infringing on our rock-solid patents
In general, what are the next major goals of your company and what are the next steps in reaching those goals?
*
What prior investments or debts (if any) does your company have?
*
Outline your company’s gross revenue and cost incurred for each individual year for the past two to three years?
*
Outline your company’s gross revenue and cost incurred for each individual year for the past two to three years.
*
What investment amount are you looking to raise in the next six months? Next year?
*
How did you find out about Opportunity Health?
*
Do you have any questions for our team?
Do you have anything else you want to share with us? Please include it here!
Submit
Should be Empty: