Supplier Sign-Up Form
Thanks for expressing interest! To request access to the latest list of Medical device part shortages, please fill out the details below:
(Note - We request that a single submission be created per organization - additional users can be added below or emailed to
Sign in to Google
to save your progress.
Please enter the name of your company or organization.
Please enter your First and Last name without initials
Please enter your phone number including area code and/or country code
Corporate Email Address
Please enter your corporate email address. This will become your login email for Med Device Network.
Please add email addresses (comma-separated) for other individuals at your company who will need access to manufacturer parts shortage lists
Example: name@domain, name2@domain, etc.
What is your role within your organization?
Your company location
My company is (select all that apply)
a medical device component supplier (ventilators, dialysis machines, or pulse oximeters)
has capability to make medical device components but doesn't currently
a non-supplier with excess medical device component inventory
a procurement specialist who can help source medical device components
a facilitator who can connect medical device manufacturers with potential component suppliers
has capability to provide 3D / additive manufacturing for production of components
has assembly capacity
can provide CNC machining
can provide metal fabrication
can provide component production
can provide engineering services
an AIA Industry Group Member (
an AdvaMed Industry Group Member
My company currently supplies parts for ventilators, dialysis machines, and/or pulse oximeters
My company currently provides operations support (engineering services, manufacturing, fabrications, QA testing etc) for medical devices?
My company makes/manufactures medical devices and has a product offering that may compete with those from manufacturers on this site.
Have additional information or comments for medical device manufacturers and/or Med Device Network? Please include it here!
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
Google Account Association
In order to access Med Device Network content, you will need to associate all emails you've entered into this form with a Google Account. Please follow the steps listed in the link below. Skipping this step may result in issues accessing manufacturing information.
Yes, I have completed the steps in the document above and associated the email in this form with a Google Account
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