Device Manufacturer Sign-up Form
To sign up as a manufacturer on Med Device Network, please fill out the following
Sign in to Google
to save your progress.
Please enter your First and Last name without initials
Please enter the name of your company or organization
Corporate Email Address
Please enter your corporate email address where you can be reached
Please enter your phone number including area code and/or country code (numbers only - no dashes or spaces)
What is your role within your organization?
Please add email addresses (comma-separated) for other individuals at your company who will need access
Your company location
Which of the following medical devices does your company manufacture?
Is the device your company manufactures approved for use in the intended jurisdiction you intend to sell in?
Yes, 510(k) or PMA approval from FDA
Yes, approval from a regulatory body other than the FDA
No, 510(k) or PMA submitted, FDA response pending
No, application submitted to a regulatory body other than the FDA
No, application has not been submitted to any regulatory body
What is your company's current production rate for the product with which you need help (units/week)
To increase production, our company needs help with the following? (select all that apply)
Is your company a member of Advamed?
Is your company a member of the Aerospace Industries Association?
Nondisclosure Agreement (NDA)
By checking this box, I certify that I have read and agree to the following NDA:
Yes, I have read and agree to the NDA
SiliconExpert (an electronic component data solutions provider) is offering full access to their analytics tools and database of over one billion parts and thousands of suppliers. Your access will remain in force for 90 days or as long as the need for ventilators continues.
For more info and to sign up, please visit
Have additional information or comments for Med Device Network? Please include it here!
Never submit passwords through Google Forms.
This form was created inside of ventconnect.org.