Emerging Innovations Vendor Submission Form

  • Your Name * Required
    The name of the person we can contact with questions about your company's product or service.
  • If you were referred to this form by a Seton or Ascension associate, or have already been communicating with a Seton or Ascension associate, please include their name(s) here.
  • The official name of your business as registered in the state where you do business.
  • Team Experience * Required
    Mark the choice that best describes your company leadership team and years of experience in this field.
  • If it is a specific product or service within your company, please name and describe it here. e.g. new MedRx medication dispenser.
  • Describe how the need/problem to be solved by your product or service aligns with the Quadruple Aim of improving health outcomes, patient experience, provider experience, and lowering cost.
  • Cost to Implement API * Required
    If applicable, please select the estimated cost to build or expand a bi-directional EMR interface functionality.
  • Number of Customers * Required
  • Please outline what your objectives are and the proposed use case for your product or service. You may consider outlining what you want to accomplish in the immediate future as well as future growth goals with Ascension.
  • Mission statement: a clear statement that represents the purpose of your company. Vision statement: a statement about how you envision the future of the company.
  • A clear statement that explains how your product solves an unmet need of Seton and/or Ascension. Quantify the value of the benefits your product or service will deliver.
  • Who are your competitors and what sets you apart? A unique, measurable, and defendable explanation of the company's product or service. It should answer the question "Why should I purchase the product or service from you versus all other alternatives on the market, including purchasing and/or doing nothing?"
  • To which market segments do you plan to sell your product or service? Describe the end-user of your product or service. e.g. geriatric patients and their caregivers struggling to navigate available resources.
  • Annual Revenue or Existing Funding * Required
    What is your company's annual net revenue? Or, what is your level of existing funding?
  • Scalibility * Required
    How widely can your product or service be scaled?
  • Product/Service Maturity * Required
  • Market Size * Required
    What is the estimated number of individuals who are potential buyers of the product or service?
  • Market Growth * Required
    What is the estimated compound annual growth rate for your market?
  • Competitive Landscape * Required
    Estimated number of direct competitors.
  • Upload any documents you may have received (e.g. one-pagers, pitch decks, overviews, business cards, peer-reviewed literature, pictures of prototypes) related to this new product or service.
    Drop files here or
    Accepted file types: jpg, pdf, doc, gif, png, xls.
      Allowed file extensions - jpg pdf doc gif png xls.
    • This field is for validation purposes and should be left unchanged.