*required fields.

1. Which healthcare sector applies to your company? *
Medical Devices / Diagnostics
Healthcare IT
Healthcare Services

2. Has the company's product received regulatory approval or clearance? *
Choose one Yes, FDA Yes, CE Mark FDA submitted & in process CE Mark submitted & in process No N/A
3. What is the company's total LTM revenue? *
Choose one $0 $1 to $1 million $1 million to $5 million > $5 million
4. What is the focus of the company's value proposition? *
Clinical Quality Improvement
Cost Savings
Enhanced Patient or Clinician Experience

5. Does the company's executive leadership have prior experience with a venture-backed company? *
Yes No
6. What is the total financing round size and how much are you seeking from AHV? *

Total Financing Round: * Select a level < $5 million $5 million to $15 million $15 million to $25 million > $25 million

Desired AHV Participation: * Select a level Up to $5 million $5 million to $10 million $10 million to $20 million

7. How much capital is required for the company to reach cash flow breakeven? *
Select an amount < $5 million $5 million to $15 million $15 million to $25 million $25 million
8. Additional Comments (limit 500 characters):
9. Attach Business Plan document (.PDF, .DOC or .DOCX). Max filesize 20MB: