Investment Preferences Questionnaire

Investment Preferences Questionnaire
Account ID
Type of Investor for Form
Calculated Form Title
General Information
Company Name*
Preferred Contact*

First NameLast Name
Preferred Contact Email*
example@phazemos.com
Please confirm that you are an accredited investor*

Yes

Investor Information
What type of investor are you?*

Bank fundBusiness angelCorporate investorFoundationInstitutional investorLeasingPrivate investor / family officePublic fundVenture capital fundOther
If you selected "other" above, please describe your investor type below.
What is the average ticket value for investment? (in millions)*
What industries are within your investment criteria? (check all that apply)

Biotechnology - Therapeutics and DiagnosticsBiotechnology - OtherBiotechnology - R&D ServicesDigital HealthInvestorMediaMedical TechnologyPharma (fully integrated)Professional Services and ConsultingPublic / Non-Profit Organizations / Medical FacilitiesSupplier & Engineering
(Biotechnology - Other) Select your business area (check all that apply)

AgBioCosmeticsEnvironmentalFoodIndustrial BiotechnologyNutraceuticalsVeterinaryOther
(Biotechnology - R&D Services) Select your service area (check all that apply)

Analytical servicesBiochipsBioelectronicsBioinformaticsCell cultureCMO (Contract Manufacturing Organization)CRO (Contract Research Organization)Diagnostic instrumentationDiagnostic servicesDrug deliveryFill & finishGenomicsProteomicsScreeningSynthesis servicesOther
(Biotechnology - Therapeutics and Diagnostics) Select your modalities (check all that apply)

AntibodiesAntibody-drug-conjugateAnti-infectivesBiosimilarsCell therapyDrug deliveryGene therapyGenericsImmunotherapyMicrobiomeMolecular diagnosticsNatural CompoundsNucleic acid drugsPeptidesProteinsSmall moleculesStem cellsVaccinesOther
(Digital Health) Select your service area(s) (check all that apply)

Artificial intelligence (AI)Doctor NetworksElectronic Medical Record / Electronic Health RecordHealth & Wellness (IoT)Health Services SearchHealthcare Mobile CommunicationMedical Big Data & analyticsMobile Fitness / Health AppsOnline Health CommunitiesPatient EngagementPayments & InsurancePopulation Health ManagementPredictive AnalyticsRemote MonitoringTelehealthOther
(Investor) Select your service area(s) (check all that apply)

Bank fundBusiness angelCorporate investorFoundationInstitutional investorLeasingPrivate investor / family officePublic fundVenture capital fundOther
(Media) Select your service area(s) (check all that apply)

News agencyNewspaperOnline publicationTrade pressTV & RadioOther
(Medical Technology) Select your service area(s) (check all that apply)

Active implantable devicesAnaesthetic and respiratory devicesBiomaterialsCoatingsDelivery devicesDental devicesDiagnostic and therapeutic radiation devicesDiagnostic devicesElectro mechanical medical devicesHospital hardwareImagingNon-active implantable devicesOphthalmic and optical devicesRegenerative MedicineReusable instrumentsSingle use devicesTechnical aids for disabled personsWound careOther
(Pharma (fully integrated)) Select your modalities (check all that apply)

AntibodiesAntibody-drug-conjugateBiosimilarsCell therapyDrug deliveryGene therapyGenericsImmunotherapyMicrobiomeMolecular diagnosticsNatural CompoundsNucleic acid drugsPeptidesProteinsSmall molecule therapeuticsStem cellsVaccinesAnti-infectivesOther
(Professional Services and Consulting) Select your service area(s) (check all that apply)

Business developmentCommunication & PR/IRDeal arrangerDrug development consultingDue diligenceEvent organizationFinancial servicesHuman resources servicesInformation providerIT servicesLegal servicesManagement consultingMarket accessMarket researchOperations/Health & safety/PurchasingPatents & TrademarksProperty management/Real estateRegulatory AffairsReimbursement & PricingSales & MarketingTechnology transferTranslation servicesValuationOther
(Public / Non-Profit Organizations / Medical Facilities) Select your organization type (check all that apply)

FoundationGovernmental organizationHospitalIndustry associationInstitutePrivate clinicResearch facilityScience / Technology parkUniversityOther
(Supplier & Engineering) Select your product/service (check all that apply)

APIs (active pharmaceutical ingredients) and excipientsChemicalsDistributorsElectronicsInstrumentationLaboratory consumables and reagentsLaboratory engineeringLaboratory equipmentMedical devicesPackaging & labelingPrecision mechanicsProduction engineeringSoftwareSynthetic materialsOther
Industries within Investment Criteria - If you selected other, please list any details below
What is your therapeutic focus? Select as many as you like*

AgnosticAdrenalAestheticsAnti-infectivesAMRAutoImmuneCardiologyCardiovascularCNSContraceptionDermatologyDiabetesEndocrinologyGastroenterologyGeneticsGIGynaecologyHematologyHepatologyImmunologyImmuno-oncologyInfectious DiseaseInflammationMen's HealthMetabologyMusculoskeletalNASHNephrologyNeurologyNeuromuscularNeuro-oncologyNutritionObesityOncologyOphthalmologyOrthopedicsPainPediatricsPhysiologyProbioticPulmonologyRare Blood DiseaseRare DiseaseRenalRespiratoryRheumatologySexual HealthUrologyVascular DiseaseVirologyWomen's HealthWound CareOther
If you selected "other" above, please describe the additional therapeutic focuses below.
Do you require the investment opportunities to be in a certain geography? Select as many as you like*

AllAfricaAsiaEuropeOceaniaSouth AmericaUSA & CanadaOther
If you selected other in the question above, please list the specific countries below:
What is your preferred phase in development? Select as many as you like*

Therapeutics: DiscoveryTherapeutics: Lead OptimizationTherapeutics: PreclinicalTherapeutics: Phase ITherapeutics: Phase IITherapeutics: Phase IIITherapeutics: On the MarketDiagnostics/Medical Devices: In DevelopmentDiagnostics/Medical Devices: On the MarketOther
If you selected other above, please describe your preferred phase in development below.
What stage do you invest? Select as many as you like*

Pre-SeedSeedSeries ASeries BSeries CPost-IPOOther
If you selected "other" above, please describe the additional stages below.
Are you open to repurposed therapeutics?*

YesNo
Are you open to combination therapeutics?*

YesNo
Are you interested in "service for equity", government R&D tax credit initiatives, or "in kind" investments*

YesNo
Do you prefer to invest in platform technologies?*

YesNo
Do you lead investment rounds?*

YesNo
Should be Empty:

Investment Preferences Questionnaire

General Information

Investor Information