Patient Screening
Application

Please complete this brief online screening application to begin the onboarding process for our IRB-approved mesenchymal stem cell protocol located in Grand Cayman.

It is highly recommended that you review our FAQ Page before continuing.

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Initial Screening

To determine if you are a suitable candidate to begin the onboarding process.

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Treatment Prerequisites

These will allow our medical team to ensure patient safety and optimize treatment efficacy.

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File Review

Once your prerequisites have been submitted for review, our medical team may provide final clearance.

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Schedule Treatment

Once approved, you may book your treatment on your desired date, subject to availability.

It is highly recommended that patients review our FAQ Page before continuing.

Please answer the following screening questions to determine if you are a candidate to begin the pre-treatment process for our stem cell program.

COVID-19 Update: Our ports of entry are currently closed for international travel. We are still accepting patient applications for future treatment dates, and our medical team is still processing incoming patient pre-treatment packages. Once a patient has completed their pre-treatment requirements, they will be put on a contact list to schedule a treatment date at earliest availability.

Form completion time: under 3 minutes.

Step 1

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Begin application →

This is a patient-funded program

I understand that this is a patient-funded program and treatment cost starts at $25,000 USD. Travel and accommodation are not included. (Interest-free financing available for US residents)

Yes

Step 2

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Please acknowledge the above statement in order to continue.

Please select at least one option.

Between the age of 18-80?

Applicant must be between the age of 18-80 in order to be eligible for treatment at DVC Stem.

Yes

Step 3

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Applicant must be between the age of 18-80 in order to be eligible for treatment at DVC Stem.

Please select at least one option.

Capable of international travel?

DVC Stem is located in Grand Cayman. Candidate must be physically, mentally and legally able to travel internationally to our clinic for treatment.

Yes

Step 4

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Our clinic is located in Grand Cayman. Patient must be able to travel internationally.

Please select at least one option.

Pregnant?

Is the candidate pregnant or at risk of being so?

Yes

Step 5

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Please select at least one option.

Cancer diagnosis?

Is candidate currently diagnosed with any type of cancer?

Yes

Step 6

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Any active cancers will disqualify patient for treatment.

Please select at least one option.

Active or chronic viral infection?

This includes HIV1, HIV2, Hepatitis B or Hepatitis C.

Yes

Step 7

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Please select at least one option.

Current medical condition

We specialize in treatments for Autoimmune conditions & Chronic Inflammation. We do not provide localized site injections.

Medical Condition (required)

Current Diagnosis

Step 8

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Please complete the fields above.

Medical history

Please describe your current symptoms and medical history. Providing detailed information will help speed up the application proccess.

Current symptoms / medical history

Step 9

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Please complete the field above.

Treatment goals

Please include a brief description of what you hope to achieve with treatment. This will help our medical team better understand your unique goals.

What are your treatment goals?

Step 10

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Please complete the field above.

Candidate information

Please include full name, age and gender.

First Name

Last Name

Age

Gender

MaleFemale

Step 11

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Please complete all fields above.

Contact information

Please submit your email information below so our patient management team may respond to your application. There are no obligations associated with completing this form.

Final Step

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Email Address

How did you discover DVC Stem?

Patient Screening
Application

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Success!

Frequently Asked Questions

Patient ScreeningApplication

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Success!

Frequently Asked Questions

Patient Screening
Application