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Application for economic assessment of a health technology-English version
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Full name
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Your answer
Contact e-mail address
*
Your answer
Which axis are you part of?
*
Musculo-Skeletal and Nervous System
Cardio-vascular, Pulmonary, Renal and Digestif Systems
Skin and Ocular Systems
Hematology, Oncology and Immunology
Short summary of the project
Your answer
Description of the technology of interest
Your answer
Actual status of the technology
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Preclinical preliminary results
Preclinical advanced results
In clinical trial
Already approved by Health Canada
Standard of care for target condition
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Your answer
Relevant bibliography references (max.5)
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Your answer
Name of member of the team who is affiliated with ThéCell Network
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Your answer
Expected delay for our first response
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Within two weeks
Within a month
Within two months
Availabilities for online meeting via zoom
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Morning preferred
Afternoon preferred
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