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* 1. Please select which stream of the Accelerator you are applying for.

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* 2. What problem are you trying to solve with your product or innovation?

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* 3. Please briefly describe your solution / product here.

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* 4. From your current understanding, who is likely to a) use the product, b) purchase the product c) benefit from the product?

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* 5. What stage is your company at?

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* 6. What progress have you made towards evidence of safety, efficacy and effectiveness (e.g. CE marking, clinical trials, pilot studies etc.)?

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* 7. Please describe your team (number of people, skillsets, full or part time)

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* 8. Have you raised any investment or grant funding for your business, or won any monetary prizes?  If so, please provide an outline of the amount and source (e.g. £100,000 angel investment round; £50,000 Smart grant, etc.)

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* 9. Which of the following benefits are likely to be delivered by your solution?  Please tick all that apply.

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* 10. Do you fit into any of our thematic areas?  If so, please tick below the ones that are relevant.  This is not necessary to enter the accelerator, but we may be able to offer additional support in these areas.

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* 11. Have you taken part in any other accelerator, incubator or support programmes? If so, please list them here.

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* 12. What would you like to learn from the Accelerator?  What questions can we help you answer?

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* 13. Name and job title of delegate

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* 14. How would you describe your role? (please tick all that apply)

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* 15. Please add your contact information

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* 16. Website and social media (please add any relevant links)

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* 17. How did you hear about TheHill's NHS Market Access Accelerator?

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