Company Intake

This form helps us assess your fit with VelocityTX’s ecosystem. Please provide full context, as that will help us best prepare for a conversation.

Fields marked * are required. We will be in touch within 3 business days.

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Section 1 — Company basics

Company name *Website

Primary contact — first name *Primary contact — last name *

Role / title *Email *

PhoneHeadquarters location *Year founded

Number of employees

Section 2 — Technology

Technology description *

Product category *Current TRL

Current development stage

Section 3 — Military and federal fit

Specific military medical use case

If you are unsure whether your technology has a military application, describe the clinical problem it solves and we will assess the fit.

Target military end users

Combat medics / 68WsCorpsmen / IDCsFlight medics / PJsMilitary nursesMilitary physicians / surgeonsPrehospital / EMS providersMTF clinical staffNot yet identified

Existing federal relationships

None currentlyInformal contacts only — conversations but no formal agreementsActive formal engagement — SBIR, CRADA, research partnership, or contract in place

Identified federal funding opportunity

Yes — there is a specific SBIR, CDMRP, MTEC, DHA BAA, or other opportunity we are targetingNo — we are aware federal funding exists but have not identified a specific opportunityNot sure — we need help identifying what is available

Section 4 — Company structure

Ownership structure *

Domestic only — all owners and investors are US persons or US entitiesInternational investors (minority) — foreign investors hold less than 25% and do not control the companyInternational parent or controlling owner — foreign entity holds majority stake or has control rightsNot sure / complex — ownership structure is complicated or we are unsure of the implications

Veteran-owned statusEntity type *

Section 5 — What you are looking for

Primary need *How did you hear about VelocityTX?Referral details (optional)

Submitted information is received by the VelocityTX innovation team and used to prepare for your discovery conversation.
We will be in touch within 3 business days.