Patient resting during IV therapy treatment
Patient Intake

Find Out If You're a Candidate

Answer five short questions about your history. There are no wrong answers — this helps our case manager understand your situation before reaching out personally.

Question 1 of 520%
Question 1 of 5
Have you been diagnosed with Lyme disease or a tick-borne illness?
This includes a formal diagnosis or strong clinical suspicion from a physician.
Question 2 of 6
How long have you been experiencing persistent symptoms?
Symptoms that continue despite treatment or have never fully resolved.
✓
Less than 6 months
✓
6–12 months
✓
1–3 years
✓
More than 3 years
Question 3 of 6
Which of these symptoms do you currently experience?
Select all that apply.
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Persistent fatigue and low stamina
✓
Muscle aches or widespread body pain
✓
Brain fog, memory strain, or reduced focus
✓
Sleep disruption or non-restorative sleep
✓
Neurological symptoms (tingling, sensitivity, neuropathy)
✓
Joint pain or inflammation
✓
Post-exertional malaise (crashing after activity)
✓
Chemical or environmental sensitivity
✓
Mood dysregulation, anxiety, or depression
Question 4 of 6
Have you tried previous treatments for your condition?
For example: antibiotics, antivirals, herbal protocols, mold protocols, or other integrative therapies.
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No prior treatment yet
✓
Antibiotics — with partial improvement
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Antibiotics — with little to no improvement
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Multiple treatment types — still not resolved
Question 5 of 6
How ready are you to explore advanced treatment options?
This helps us understand where you are in your decision process.
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Still researching — just gathering information
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Seriously considering — want to know if I qualify
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Ready to move forward — looking for the right option
✓
Urgent — symptoms are significantly affecting my life
You appear to be a strong candidate
Let's connect you with our case manager
Based on your answers, our team would like to review your full history with you. Please share your contact information and we'll reach out within one business day.

Your information is confidential and will only be used to contact you about your case.

Question 6 of 6
Which program are you most interested in learning about?
This helps our case manager prepare your consultation — no commitment required.
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12-Day Program — Treg, apheresis and IV therapy: clear, rebuild, restore
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18-Day Program — Everything in 12 days, plus Heckel hyperthermia
✓
Not sure yet — I'd like guidance from your team
🌱

Your intake has been received

Thank you for taking this step. Our case manager will personally review your profile and reach out within one business day.

For immediate assistance:

📞 619.567.4203 mbarajas@immunotherapyinstitute.com
Call us