• Submit a Case via Form Upload

    File Upload & Payment

    Use this option if you have completed a paper or PDF version of the Case Management Request Form and and would like to upload it directly during payment.

    This option combines form submission and payment into a single step.

    Step 1 – Upload the Case Management Request Form

    Upload the completed Case Management Request Form using the secure upload field provided within the payment form below.

    Step 2 – Submit Payment to Initiate the Case

    During checkout, remit the $250 Case Initiation Fee by credit card, debit card, or ACH.

    Step 3 – We'll Take It From Here

    Once both the completed form and payment are received, BioConnetiX will initiate case coordination in accordance with the authorized scope and provide updates as services are coordinated.

    Need a Form?

    Download a PDF version here
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