Betsi Cadwaladr University Health Board
Industry Partnering Service
Please complete this short form to provide us with some information about your company, it’s
products and the clinical area(s) in which you think your products might be used.
Company Name:
Company Address:
Contact Name:
Contact Phone:
Contact Mobile:
Contact Email:
Company Website:
Product or Project Name:
Brief Description of Product (including stage if development e.g. idea, proof of concept, testing
required for CE marking, CE marked)
Please indicate below the Clinical Area(s) in which you think your product could be used. (e.g.
clinical speciality, disease area, target patient population, primary or secondary care). If known please
state this.
What Are Your Objectives? e.g. What do you wish to prove or learn?
Details of Existing Collaborators in Wales (if any)
Are you already collaborating with anyone outside Wales (Please give details)?