Submit a Case

Start your secure case file.

Encrypted intake · Care coordinator reaches out within one business day · You can pay before or after we confirm scope.

🔒 Encrypted from your first keystroke. All fields and uploads use TLS in transit and AES-256 at rest. No PHI is ever sent by email.

Case details

Review tier

Specialty

Clinical question

Brief clinical history

🔒 Records upload happens in the Secure Portal — a coordinator will email you a HIPAA-covered upload link within one business day. Don't attach records to this form.

Your details

First name

Last name

Phone (with country code)

Country

Treating physician (name & email)

Payment

You can pay now via the Secure Portal, or wait for our coordinator to confirm scope first.

Pay $350 Standard Pay $900 Complex Pay later

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