Medical Supplier Assessment Profile

All information provided will be used to assess eligibility for participation in the Medical Supplier Distribution Network Program. There are no wrong answers. This "Assessment" is designed to help us better understand your needs and compatibility with the program. Please do your best to answer each question. If you need more room for your answer, use the comment section.

Important: Please read before you begin.

Closing date for submission of Medical Supplier Assessment is April 19, 2025. Upon completing your assessement, you will be re-directed to either request a payment plan with a minimum initial deposit or purchase the program in full at a discounted price for a limited time to hold your space in the program. Upon receipt of your assessment and payment, you will be set-up for a 1 on 1 discussion with Michelle Brown. 1 on 1 interviews begin April 21, 2025. Program Orientation is April 26, 2025.

All responses are kept strictly confidential. For questions please contact the support team via email at Fedbiztraining@outlook.com.

Business Name Legal and DBA*

Year Established*

Primary Contact Name Title*

State Business Location(s)*

State location helps us to determine information about your target market.

Telephone Number*

Email*

example@example.com

Website Y/N or N/A

If you do not currently have a site use N/A

UEI SAM Registration Active Y/N *

Do you currently have a State Medical or Wholesale Licenses (medical wholesale pharma) Y/N*

Are you participating in any of Michelle Browns programs? If so which one(s).*

What types of of medical products would you like to supply? (check all that apply)*

List the preferred types of medical supplies you would like to offer if known*

In which markets would you like to offer Medical Supplies Government, commercial or both?*

Do you have a specific target market you prefer, ex clinics, hospitals, consumers? *

Are you signed up to work with any Medical Suppliers, such as Mckesson, Cardinal, Owens Minor, Henry Schein, etc? Please list all:*

If you become an authorized Medical Distributor or Representative, how would you distribute your products? (check all that apply)*

Comments

Warehouse is not required. Do you currently operate a warehouse or storage? Y/N*

Locations if applicable Y/N or N/A*

Square footage Y/N or N/A*

Climate control? Y/N or N/A*

How will orders be shipped? (Check all that apply):*

What geographical areas will you target to sell your Medical Supplies, cities, counties, etc.*

Comments

How much Medical Supply volume do you expect to handle monthly?*

Staffing Capacity

Total # of staff*

Will you have a customer service team or person?*

Will you have a sales team or person to focus on selling your products?*

What questions or concerns do you have about running your own Medical Supply company?*

What are your revenue goals for Medical Supply sales monthly?*

If needed but not required, will you have some working capital?*

Are you willing to secure liability insurance when needed?*

Has your company won any Government or Commercial contracts? If yes describe.*

Comments

Why are you interested in the Medical Supply industry?*

Are you open to cobranding or white labeling opportunities?*

White labeling is products that are already made, however you can place your company name on the product.

Are you interested in Medical Distributorships Partnerships?*

Do you or will you offer net terms or financing options to your clients?*

Do you currently service any Medical or Healthcare industries? (ex. hospitals, nursing homes, government, clinics, dental, etc)? *

Comments

Authorized Company Representative Name*

Title*

Signature*

Medical Supplier Assessment Profile

Section 1: Business Information

Section 2: Product Capabilities

Section 3: Distribution & Fulfillment

Section 4: Business Operations & Capacity

Section 5: Financial & Compliance

Section 6: Growth & Partnership Readiness

Section 7: Signature & Attestation