Treatment Cost

I understand that this is a patient-funded therapy and treatment cost is a minimum of $9,000 USD. (Accommodation at a premium hotel is included, but travel is not). *

Yes, I understand.

No, I can't afford it.

BioGenesis is situated in Panama City, Panama. Candidates must be physically, mentally, and legally capable of traveling to our clinic for treatment. If you have mobility challenges, please ensure you travel with a companion. *

Yes, I can travel to Panama.

No, I can't travel.

Cancer Diagnosis?

Is candidate currently diagnosed with any type of cancer? *

Yes

Pregnant?

Is the patient currently pregnant or at risk of pregnancy? *

Yes

Contact Information

Please enter your email address below so our team can respond to your application. Completing this form carries no obligations.

Full Name

Email *

Phone *

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Candidate Information

Date of birth *

Gender *

Please select the medical condition that best describes your case below. *

Current Diagnosis & Symptoms (Optional Additional Information).