To be screened for eligibility

To participate in the clinical trial

Registration
  1. To request further information, simply fill up the required fields (indicated by an asterisk) below.
  2. Patient Name(*)
    Please type your full name.
  3. Address(*)
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  4. Country(*)
    Select your country
  5. City(*)
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  6. State
    Please select your state
  7. Zip(*)
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  8. E-mail(*)
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  9. Phone (ex: 123456)
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  10. Gender



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  11. Birth Date
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  12. What kind of cancer do you have?(*)
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  14. Please indicate where you have metastases. (Check ones that apply)









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  16. Please indicate what kind of treatment have you already received?

    Surgery to remove the primary tumor(s) with or without radiation and:



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  18. Already received treatment for metastatic disease with:




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  20. What is the current stage of the disease? (Please select from the drop down menu)
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  22. How has the cancer affected your daily activity? (Choose the one statement that best describes your daily activity level.)
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  24. Are you able and willing to travel to Carlsbad, California to participate in the clinical trial if you qualified?



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  26. Are you able to pay the $15,000 in medical costs for the clinical trial if you qualified?



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  28. Questions
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  29.   
Clinical Trial of an Experimental
Cancer Vaccine
  • Personalized experimental anti cancer vaccine
  • Combines tumor cryoablation with AlloStim™

CryoStim™ Animation

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