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Organisation Details

Company size
Company category

Summary of the innovation

(one innovation per application)
Is the innovation a product or a service?

Progress to date

Tell us briefly about any external funding / support you have received in support of developing your innovation
(tick all that apply)
Which of the areas below does your innovation impact on?
Clinical specialty areas
Pain Management
Non-clinical specialty areas
(Please select no more than 4)
In what setting will your innovation be used?
(Please tick all that apply)
 (e.g. clinical impact, patient feedback, cost effectiveness - include savings for the Health and Social Care system and period of return on investment). Please provide links to sources, case studies, published papers, expert opinion, independent evaluation (e.g. NICE, etc.)

AHSN engagement

Have you already discussed this innovation with any AHSN?
Please select all that apply
Which AHSN areas would you like to engage further with?

Next steps

What support are you now seeking?
How did you hear about us?
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