JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Unmet Clinical Need/Problem Statement
Welcome to BETIC network and ecosystem (
www.betic.org
). Medical device innovation relies on close collaboration between doctors, researchers, innovators and entrepreuners. This form is intended for clincians and industry partners to share an unmet clinical need with BETIC to initiate a collaborative project. We look forward to hearing from you.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Disclaimer
BETiC receives multiple unmet clinical needs from clinicians and companies all over the country. The team evaluates these for potential innovation, commercialization and impact for prioritizing the projects to take forward. Communication will be initiated with only these projects. Please refrain from sharing/declaring any confidential information or ideas/solutions in this form. We may receive the same or similar needs from multiple sources. Thank you.
Full name
*
First - Middle - Surname
Your answer
Mobile number
*
Your answer
Organization/Affiliation
*
Your answer
Expertise/Specialization
*
Your answer
Domain of the proposed problem
*
(ex: Type of disease/deformity/medical condition, treatment method/procedure/surgery/rehabilitation)
Your answer
Specific problem area within domain
*
(ex: Diagnosis/screening of disease; specific step in surgery/procedure; assistive/supportive/reconstructive; monitoring, adherence)
Your answer
Existing solutions for the problem
*
(ex: Devices, methods, procedures, equipment)
Your answer
Limitations of existing solutions
*
(ex: Efficacy (outcome, accuracy), efficiency (effort, speed); learning curve, skill, comfort, convenience; resource/infrastructure dependency; cost (capital, maintenance and running/usage))
Your answer
Detailed description of the problem
*
(About 100-200 words)
Your answer
Potential impact (if the problem is solved)
*
(ex: Prevalence (number of people affected), mortality/morbidity, economical impact)
Your answer
Do you have any funding source to develop the solution?
*
Yes
No
How can you support further development?
*
Access to clinic/hospital to understand the problem
Clinical feedback throughout the development
Clinical studies at your/other hospital
Manufacturing/testing facility/resource
Product marketing and distribution
Funding to develop the solution
Other:
Required
Thank you very much.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of BETIC: Biomedical Engineering and Technology Innovation Centre, IIT Bombay.
Report Abuse
Forms
