ADEPT Client Intake and Project Description Form

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Please provide as much information about your project as you are able so that we can connect you with the appropriate experts to assess your requirements further. After reviewing your inquiry, we will contact you to set up a technical consultation to more about your project and help you advance your technology through the health innovation cycle.

There is no fee for a consultation, but there are fees associated with services and samples. We will be able to provide you with a cost estimate after we have more information about your needs.

Email *

Name of Primary Contact person for the project

Primary Contact email address

Primary Contact telephone number

Name of Organization (your primary affiliation in relation to this project)

Website of Organization

Address of Organization

Type of Organization

Multi-national enterprise (MNE)

Small or Medium sized Enterprise (SME)

Start-up

Not-for-profit organization (NFP)

University

Other:

Clear selection

Is a confidentiality agreement required before a technical consultation?

Yes

Other:

Clear selection

Health Innovation Cycle

Alberta Innovates has developed a Health Innovation Cycle Matrix that is used to characterize the current state of commercialization of a technology across 4 key domains. Please refer to the Matrix to answer the next 2 questions.

The Matrix can be found here: https://drive.google.com/file/d/1WSfg8gEzg_35OjzItCf8RbyE7ufb9Lol/view?usp=sharing

The Health Innovation Cycle Matrix describes the major steps in the Client Journey. Please indicate which step(s) you are on for your technology (select all that apply).

1. DISCOVERING (Need identification): Insights into unmet health need and state of the art solutions.

2. IDEATING (Idea Generation): Potential solutions to unmet need described, evaluated and selected.

3. CONCEPTUALIZING (Proof of Concept): Key component concepts validated in models and value proposition tested.

4. COMMITTING (Proof of Feasibility): Feasibility of whole solution demonstrated in models and in feeedback from stakeholders.

5. VALIDATING (Demonstrating Value): The potential of the solution to work and create value for all stakeholders is demonstrated.

6. VALIDATING (Clinical and End-user Safety and Feasibility): Clinical, end-user and economic data collected, and endpoints achieved through initial trials.

7. VALIDATING (Clinical and End-User Efficacy): Clinical, end-user and economic data collected, and efficacy endpoints achieved through pivotal trials.

8. SCALING (Real-world implementation): Institutional and regulatory approval received, and sales launched.

9. ESTABLISHING (Clinical Use): The solution is used successfully in day-to-day clinical practice.

10. LEADING (Standard of Care): The solution is recognized as standard of care.

Other:

The Health Innovation Cycle Matrix identifies 4 key domains in the innovation cycle. Except for the first stage (Discovering), there are milestones to be met in each of the 4 domains. Please indicate which of these domain(s) you need help with currently. (Select all that apply)

Product-Market fit

Business Readiness

Regulatory Compliance

Product Development

Other:

What technology readiness level (TRL) is your project/technology currently at? Please refer to Alberta Innovates TRL definitions: https://albertainnovates.ca/app/uploads/2018/05/Technology-Readiness-Levels.pdf *

Level 1

Level 2

Level 3

Level 4

Level 5

Level 6

Level 7

Level 8

Level 9

Required

Project Description and Requirements

Please provide a brief description of your project so that we can determine who we should engage internally to meet your project needs best.

NOTE: Please do not include any confidential information if a Non-Disclosure or Confidentiality Agreement is required but not in place.

Are you interested in accessing laboratory services, and/or do you need access to lab space?

Lab services only

Lab space only

Accredited lab space

Biosafety Level III containment lab space

A combination of services and space

I am not sure yet

Other:

What type of services or space do you require? (please check all that apply)

Genomics (somatic and germline)

Proteomics

Metabolomics

Hematology

Clinical Chemistry (including urinalysis)

Microbiology

Anatomical Pathology - Cytology

Anatomical Pathology - Histology

Molecular Pathology

Immunology and Immunogenetics

Infectious Disease and Public Health (including Level III containment)

Point of Care Diagnostics

Other:

Please specify the services that you require (if known).

Please indicate any specific equipment that you require (if known).

ADEPT can provide expert consultation in a number of areas. Some broad categories are listed here. If expert consultation is required, please choose the category(ies) that you are interested in. If what you need is not in the list, please use the "other" category to describe what you need.

Process Excellence

Quality Assurance Systems

Lean Lab Process Design

Transport Logistics

Data Integration and Result Reporting

Lab Accreditation

Do you require access to office space?

Please note that availability of office space is limited, and if available can only be accessed on a short-term basis.

Yes

I'm not sure yet

Clear selection

Do you require access to clinical samples for testing?

Please note that there will be a review process undertaken to assess project details such as strength of preliminary data, availability of required samples, and feasibility of experimental plans before releasing samples. We cannot guarantee availability, fitness or access to any clinical samples before completion of this review.

Yes

I don't know yet

Other:

Clear selection

If clinical samples are required, please indicate the type of clinical samples needed. (state "n/a" if not needed)

Do you require clinical data along with the samples?

Yes

Maybe

I do not need clinical samples

Clear selection

Please indicate what clinical data you require along with the samples, if applicable.

Estimate quantity of samples needed (state "n/a" if not needed)

Timeline

Please provide information about your time constraints and requirements.

What is your anticipated START DATE for this project?

YYYY

What is your anticipated END DATE for this project?

YYYY

Please provide any important information regarding your timeline (e.g. do you have a funding deadline that requires the project to be completed by a certain date?)

Do you agree to completing a post project survey with ADEPT to allow us to understand the value of the program and collect performance metrics? *

Yes

Required

Is there anything else that you would like us to know?

A copy of your responses will be emailed to the address you provided.

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