Treatment Cost

I understand that this is a patient-funded therapy and treatment cost is minimum $10,000 USD. (Travel and accommodation are not included). *

Yes, I understand.

No, I can't afford it.

Capable of international travel?

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.

Pregnant?

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

Yes

Cancer Diagnosis?

Is candidate currently diagnosed with any type of cancer? *

Yes

Active Viral Infections

Does the patient have any active viral infection? This includes HIV-1, HIV-2, Hepatitis B, and Hepatitis C. We cannot accept patients with active viral infections. *

Yes

Diagnosis

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

Current Diagnosis (Optional Additional Information).

Current Symptoms

Please describe your current symptoms (Optional).

Treatment Goals

Please provide a brief description of your treatment goals, as this will help our medical team understand your unique needs. *

For Example: Reduction in pain, improved energy, etc.

Candidate Information

Last Name *

First Name *

Date of birth *

Gender *

Contac Information

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

Email *

Phone *

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