Health Innovation Inquiry Form

Please provide all details to ensure that the team has the necessary information to proceed efficiently with the next steps.

Full Name*

Email Address*

What organization are you a part of?*

Where are you located?*

Nova Scotia

Canada

Other

Which of the following best describes you?*

I work for or founded a startup company

I have an idea or problem that I would like to share

I work for a corporation

Are you affiliated with Nova Scotia Health?*

Yes

Startup Questions

What best describes the stage of the company?*

Pre startup: The company is in the planning phase, focusing on idea development, market research, and preparing for launch.

Startup: The company has launched its product or service and is working on gaining initial customers and refining its business model.

Breakout: The company is experiencing rapid growth, expanding its customer base, and scaling operations.

Traction: The company has a proven business model, steady revenue, and is focused on optimizing and scaling its operations.

Select or enter value

What resources, programs, funding sources, accelerators, or supports have you engaged with?

Idea/Problem Sharing Questions

Which of the following would you like to share?*

An idea to solve a problem

A problem I am experiencing

What is the problem you are experiencing? Please give mention to qualitative and quantitative descriptions of the problem.*

What is the impact of this problem on patients, practitioners and/or the health system?*

Do you know of any models/solutions that may be able to address this problem in Nova Scotia?*

Please briefly explain what you would like to discuss.*

Corporation Questions

What stage is your innovation currently at?*

Select or enter value

Where is this product currently deployed and available?*

Why do you consider your proposed product or partnership innovative?*

Please describe the potential impact(s) of your proposed innovation for patients and/or the health system. Please give mention to qualitative and quantitative impact metrics.*

Health Canada Questions

Does your product currently have Health Canada approval?*

Yes

What is the Health Canada approval class of your product?*

Class I (Low Risk)

Class II (Moderate Risk)

Class III (High Risk)

Class IV (Highest Risk)

Is it on your roadmap to obtain approval?*

Yes, in progress

Yes, planned for the near future

No, not planned

What stage is your product in regarding Health Canada approval?*

Select or enter value

If applicable, do you currently hold a Medical Device License from Health Canada?*

Yes

Have you previously received Health Canada approval for other products?*

Yes

Problem Identification Questions

In 2-3 sentences what specific healthcare problem does your solution address? Please give mention to qualitative and quantitative descriptions of the problem your proposed solution is addressing.*

Problem Solution Method*

Select or enter value

Where is this intervention best positioned?*

Select

Additional Information

What are you looking to gain from interacting with the Nova Scotia Health Innovation Hub?*

Please share any relevant previous or current interactions with Nova Scotia Health and/or the Innovation Hub.

Please upload any relevant materials you would like to share.

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Send me a copy of my responses

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