For Patients, Families, Caregivers & Physicians — Compassionate-Use Intake Registry

Seeking compassionate-use access?
Begin your secure patient intake here.

Patients, families, caregivers, and treating physicians can begin a secure intake for physician-supervised compassionate-use, expanded-access, or observational registry review. The intake may support physician review, FDA Form 3926 preparation when applicable, and referral to a physician enrollment portal.

I am a Physician How We Handle Your Information

1. What kind of review are you requesting?

Select the pathway that best matches your situation. You can always describe details in the diagnosis field below.

2. Patient information

If you are a parent or caregiver submitting on behalf of someone else, fill in the patient's information here and add your name in the caregiver field.

Patient first name *

Patient last name *

Caregiver name (if applicable)

Diagnosis or condition *

Patient age *

Patient location *

Patient email *

Patient phone *

Preferred contact method *

3. Treating physician information

Compassionate-use and observational pathways require a treating physician. We will email the physician directly with a review request and a link to the BeaconCR physician enrollment portal.

Physician first name *

Physician last name *

Specialty *

Clinic or institution *

Clinic / physician website

Physician email *

Physician phone *

4. Review and submit

What happens after you submit

Physician is contacted

BeaconCR emails your treating physician an automated review request with a link to the BeaconCR physician enrollment portal.

Independent review

Your physician reviews medical appropriateness. If applicable, BeaconCR supports FDA Form 3926 preparation and observational registry routing.

Confidential handling

Your information is stored securely and shared only with the physician you list and the BeaconCR review team.

Questions about your intake? Contact the BeaconCR Patient Support Team at patients@beaconcr.com.

Submitting this intake does not guarantee treatment, study enrollment, compassionate-use access, FDA authorization, or physician approval. All requests require independent physician review and appropriate regulatory, ethical, and safety oversight. BeaconCR / Healing Hope International is an observational registry and onboarding platform, not a treatment provider.

Seeking compassionate-use access?Begin your secure patient intake here.