New Idea Submission Form

Breg welcomes innovation and your ideas to help improve patient care.

We value ideas from our healthcare partners that enhance the journey from injury to recovery.

If you’re interested in collaborating with Breg, please complete the questionnaire below. Our Innovation Team will review your submission and reach out if it’s a potential fit.

Submitter Contact Information

Name(Required)

First Last

Title

Organization(Required)

Phone(Required)

Email(Required)

Address(Required)

Street Address Unit or Suite City State / Province / Region ZIP / Postal Code Country

Product or Service Idea Information

Product Name(Required)

Intended Use(Required)

Indications for Use(Required)

Intended Patient Population(Required)

Target Market and Customer Type(Required)

List HCPCS (Healthcare Common Procedure Coding System) Codes that May Apply for this Product

Development and Commercialization Status

Description of Drawings, Prototypes, Testing or Clinical Evaluations(Required)

Have Any Patents Been Submitted or Granted?

Yes

DO NOT DISCLOSE ANY CONFIDENTIAL INFORMATION UNTIL AFTER A NONDISCLOSURE AGREEMENT IS SIGNED

Breg welcomes innovation and your ideas to help improve patient care.

Submitter Contact Information

Product or Service Idea Information

Development and Commercialization Status

Company

Patients

Providers