You've just spent three days with people who understand what you're carrying. This is where that turns into a next step that's actually yours.
Tell us where you live, what your body has been doing, and what feels realistic for you this season. We'll come back to you with the door we'd open for you, and why.
There are no wrong answers. Nothing here is a test, and none of it decides your worth. Whatever you tell us is simply what we work from.
You don't have to work out which program is yours. We'll explain which pathways our team can responsibly support right now and why. You do not need to arrive with anything decided.
Choose the investment range that feels realistic right now. If cost is a barrier, there is space to tell us before you submit.
You'll hear back from our team this week.
We saved your earlier answers. Start fresh instead
We'll never share what you tell us. Your answers go to our team and nowhere else, and applying does not create a patient relationship.
The Immune Confident Institute provides elective specialty care and education. Nothing on this page is medical advice. Clinical services are available only where our clinicians are licensed. In a medical emergency, call 911.
Privacy Policy · Terms and Conditions
All questions are below — answer what applies and press Send at the end.
There's no wrong answer here or anywhere in this form.
Please add your first and last name to continue.
Our team answers by email, usually within 48 hours.
That email doesn't look complete — mind checking it?
We won't cold-call you. This is a backup so your application never gets lost.
Please add a phone number to continue.
Some of our care is available only in certain states. This helps us point you to what you can actually access.
Please choose your state to continue.
Check anything that sounds like you — this is just a snapshot. You'll have room to go deeper later if we're a fit.
Please check at least one so we understand what you're dealing with.
Add a word or two about the "something else" so our team can read it in context.
There's no rush on our end. This simply helps us time what we suggest.
Please pick the answer closest to you.
Our pathways differ in scope, time, and level of clinical involvement. Choose the range you could comfortably consider today so we can show you the options our team can responsibly support at that level. If cost is a barrier, you can tell us before you submit.
ICI uses an AI-assisted transcription tool during clinical visits to support documentation. Consent to its use is required for enrollment in an ICI clinical program.
If you prefer not to use transcription, we can still consider you for non-clinical support.
Please choose an answer so we can show you the pathways available to you.
Choose what you're most interested in. We'll review your full application before making a recommendation.
Because you're considering clinical care, a few more questions help Dr. Wada's team review your application properly.
Check all that apply. "Not sure" is a completely valid answer.
A few words are plenty. This helps the team read your snapshot in context.
Every answer here is common, including "no one right now." It helps us see what support you already have.
Panels like ANA or SSA/SSB. "Not sure" is a fine answer — we can always order what's missing.
In your own words. This is often the most useful answer in the whole application.
A count is plenty. We don't need names or doses here.
A rough number is fine. Plenty of folks arrive here after a long search.
Money and health are both tender topics. If finances feel tight or uncertain, there's space here to share that. Being honest about it will not hurt your application or change our respect for you — it just helps us avoid suggesting anything that would add financial stress.
Almost done. If there's anything you'd like us to have in mind as we review, this is the place for it.