Product Idea Submission Form

 
*Denotes a Required Field
*Name:
*Address:
*City:
*State:
*Zip Code:
*Email Address:
*Phone Number:
*Date:
*Title or Name of Idea:

 
Please fill in as much information as possible. Do not provide any confidential or proprietary information. This form will aid Bard in assessing your idea and the value that Bard would add to the idea if both parties pursued an agreement. Bard will review this form and if the idea appears to be able to be commercialized and has a strategic fit with our business objectives, we will seek to execute a Confidentiality Agreement.

 
1. Describe your idea. Please provide enough information to determine whether your idea is commercially attractive, but do not include any confidential or proprietary information.:

 
2. Does your idea replace or improve an existing product service or is it completely new?

 
3. Is your idea for a single patient use or reusable device? If reusable, how many reuses are expected?

 
4. In what state of development is your idea?

 
5. Have you made a prototype?

 
6. Does any other individual, organization, or companies have rights to or ownership of the idea you are submitting? If yes, please indicate names and addresses.

 
7. Do you have a patent? If so, what is the status?