Are you a Candidate?

Complete this online screening form to determine your eligibility for our Autologous Cell Fraction infusion at ALIV x Solo StemCells in Pune.

Step 2/11

Procedure Cost

I understand that this is a patient-funded program and the cost is in the range of Rs. 1,00,000 to 9,00,000 depending on the classification and severity of the condition. Travel and accommodation are not included. (Interest-free EMI options available for Indian residents)

Step 3/11

Capable of travel?

ALIV x Solo StemCells is located in Pune, Maharashtra, India. Candidates must be physically, mentally and legally able to travel to our clinic for the procedure. If you have mobility issues; you will be required to travel with a companion.

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Pregnant?

Is the candidate pregnant or at risk of being so?

Step 5/11

Cancer Diagnosis?

Is the candidate currently diagnosed with any type of cancer?

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Active or Chronic Viral Infection?

This includes HIV1, HIV2, Hepatitis B or Hepatitis C. We do not accept patients with active HIV infections.

Step 7/11

Current Diagnosis

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

Step 8/11

Current Symptoms

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

Step 9/11

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.

Step 10/11

Candidate Information

Please include full name, age and gender.

Step 12/12

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.

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