New Product Evaluation Submission Form
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1New
w Product Eva
aluation Subm
mission Form
m
Conta
act Name*: ___
____________
_____________
____________
___ Email*: ___
____________
_____________
_____________
___________
Phon
e*: _________
_____________
___
Comp
pany: ________
____________
_____________
____________
___ Website:
___________
_____________
____________
___________
Addre
ess*: ________
____________
_____________
____________
_____________
____________
_____________
____________
___________
Provis
sional Patent #
#: __________
________ Utilit
y Patent #: ___
____________
______ Design
Patent #: ___
_____________
_______
Design To
Produ
uct developme
ent stage*:
Idea
Prototype
oling Sales
s Manufac
cturing
Produ
uct description
n*: __________
____________
_____________
____________
_____________
____________
_____________
___________
Produ
uct features, ad
dvantages, ben
nefits*: _____
_____________
____________
_____________
____________
_____________
__________
_____
____________
_____________
____________
_____________
____________
_____________
____________
_____________
__________
3 digi
it FDA alpha pr
roduct code*: _
____ ____ ___
__
(If unf
familiar, see link
k:
da.gov/MedicalD
Devices/DeviceR
egulationandGu
uidance/Overvie
ew/ClassifyYourD
Device/ucm0516
668.htm)
Attac
chments*: D
Design drawing
s Samp
ple/Prototype
Photo
Video
Subm
mission Terms:
I am t
the owner or a
authorized rep
resentative of
the product.
I am n
not violating a
ny confidentia
lity agreement
t.
Subm
mission is made
e on a non‐con
fidential basis
(GF recommen
nds patent pro
otection).
I unde
erstand that G
GF Health Produ
ucts, Inc. may a
already be exp
ploring a simila
ar product and
I do not assert
t any intellectu
ual property
rights
s.
Subm
missions will no
ot be returned.
Signa
ture*: ______
_____________
____________
_____________
____________
________ Date
*: __________
____________
__
Print
Name*: _____
____________
_____________
____________
_____________
________
Subm
mit to:
Email
l (with attachm
ments): produc
tsubmission@
grahamfield.co
om Mailing
g address: GF H
Health Product
ts, Inc.
Ma
il Stop 18 – Ne
ew Product Eva
al.
293
35 Northeast P
Pkwy
Atla
anta, GA 3036
60‐2808
Due t
to the number
r of submission
ns, we regret t
that we can on
nly respond to
product subm
missions in whi
ch we have in
terest.
*Req
uired Field
For G
GF P.M. Routin
g:
Ba
Medical‐Su
Perso
S
th Safety
rgical Supplies
s
nal Care
Support Surfac
ces
Be
Mobility
Respir
W
eds, homecare
ratory
Wheelchairs
Fu
Patient Lifts
Specia
rniture
s
alty Seating
Me
Patient Roo
Stretc
edical‐Surgical
Equipment
om
chers/O.R. Roo
om
Form # GF15
00048RevA15
5
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