Company name (as registered at Companies House if applicable)

Company number (if registered at Companies House)

Primary contact Name *

Position *

Company Address (as registered at Companies House if applicable)

Postcode *

Trading address (if different)

Website

Phone

Email address

1. Describe your eHealth product/service:

2. Describe the problems that your eHealth product/service will solve:

3. How is your eHealth product/service unique and different from others on the market today?

4. Who do you see using your eHealth product/service? Prioritise your top 2/3 customers.

5. How developed is your eHealth product/service in its journey to market?

We are at the very start of our journey and have no viable eHealth product/service yetWe are adapting an existing product/service into the eHealth marketWe have a minimum viable eHealth product/service to market testWe want to improve/update/innovate our existing eHealth product/service which is already on the market/in use within the health sectorWe have a product/service ready for sales/distributionWe are looking to scale up to regional/national/international marketsOther

6. Has your business/team conducted or commissioned any previous research to support your product/service and/or have you worked with a university academic before? Please include a link and/or 50 words.

7. To help us determine where you are in the eHealth market, to what extent do you agree with the following statements?

8. What are your top three priorities for EPIC support?

Is the business located in Cornwall?

---YesNo

Does the business have fewer than 250 employees?

---YesNo