Please answer the questions below so that NAFC has the latest information about your company. We are accepting information for our future Resource Guide & Discoveries on products with (expected) FDA clearance or release dates within the 2013 calendar year that have not been included in previous editions of the Resource Guide or Discoveries.

*Please note: We have now eliminated the categories of Diagnostic Equipment, Surface Support, and Alternative Medications from the Resource Guide and DISCOVERIES.

Resource Guide/Discoveries Product Listing
Company Name *

Company Address*



Zip Code*

Company Business Phone Number*

Company Toll-Free Phone Number

Company Fax Number

Company Email Address For Consumers

Company Website

Brief Company Description*

Contact Person's Name, Email Address and Phone Number (for NAFC records only)*

NAFC maintains a database of over 135,000 individuals, 90% of whom are consumers. Would you be willing to schedule a 15 minute call with NAFC to find out more about great ways to reach your audience?*

Are you interested in receiving information about advertising in NAFC's latests DISCOVERIES?*

Does your company have a new* product? (New* = products with (expected) FDA clearance or release dates after November 2009 that have not been included in previous editions of the Resource Guide or DISCOVERIES.)*

What Category Does Your New Product Fit Into?*

Product Name(s) in this category (Please indicate if this product's name is registered, trademarked, etc.)*

Please describe your new product(s) in one or two sentences.*

When was (or will) your product(s) (be) released?*

Is (are) your product(s) covered by Medicare, Medicaid, or other insurance?*

Where is (are) your product(s) available?

Who is your target audience for this (these) new product(s) (gender, age, diagnosis)?*

Please feel free to provide us with any other pertinent information or feedback. Thanks from NAFC.