Product Submission Questionnaire

Thank you for approaching Breg with your new product idea. The following questionnaire will help us with our evaluation so we can get back to you as soon as possible. Any questions marked with stars are mandatory and cannot be skipped.

Legal Info

- PLEASE READ THE FOLLOWING BEFORE SUBMITTING YOUR IDEA -

Breg will only consider initial ideas on a non-confidential basis. By submitting your idea, you are neither entering into a confidential relationship with us nor receiving any guarantee of secrecy from us. The business risks associated with confidential relationships and obligations of secrecy are too great for the company to enter into them for the purpose of preliminary evaluation of initial ideas.

Breg is not required to keep your idea confidential and that, if your idea is not protected by a patent, Breg is free to use your idea for any purpose including commercialization of your idea for the sole benefit of Breg. Your submission to us will be akin to publication of your idea. Please note also that acceptance of your submission does not oblige Breg to use the information or otherwise create an agreement between you and Breg..

Contact Info

Invention Overview

Questionnaire

Which of the following categories is/are most relevant to this product opportunity? *
 
Which of the following anatomical areas is/are most relevant to this product opportunity? *
 
What type of customer(s) are most likely to buy this product? *
 
Do medical insurance companies reimburse doctors or patients for use of this type of product in the U.S.? *
If you answered "yes" to the question above, what reimbursement code is most relevant to this product opportunity? (if you know)
 Reimbursement Information
Off-the-shelf code, if applicable:
Custom fit code, if applicable:
Custom fabricated code, if applicable:
Comments:
Do medical insurance companies reimburse doctors or patients for use of this type of product outside the U.S.? *
Please estimate the approximate price range you believe a customer would pay for this product: *
How could this product opportunity improve the current standard of care? (select all that apply) *
 
Does this product opportunity reduce the need or likeliness of any of the following? (select all that apply) *
 
Overall, what do you estimate the market size for this product opportunity to be? *
 Market Information
Patients/year
Source
Please list any existing products on the market that perform a similar function
 NameManufacturer
Product
Product
Product
Product
Product
Regarding this idea, I have: *
 
calendar calendar
calendar calendar
Which of the following best describes the nature of this product opportunity? *
How can a relationship with Breg help you? (select all that apply) *
Do you have any documented feedback on this product from relevant healthcare providers or patients? *
 
If you are a medical professional, what support would you reasonably be able to provide during a partnership with Breg? (select all that apply)
 

End of Questionnaire