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Submit your intake docket.

All fields transmitted under AES-256 + TLS 1.3 encryption. On submission you receive a confirmation docket ID and an automated email, then continue straight to payment for your selected tier. Retain your ID for all future secure communications.

CLASSIFIED
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Patient Intake Docket · Form PRI-INT-447
Rev. H-7 · Secure Electronic Submission · ----/--/--
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🛡️ All personal health information (PHI) is encrypted at rest and in transit per PRI Directive 14-7B. Your deposit is held in an escrow account and is 100% refundable until protocol eligibility is confirmed by a certified physician-agent.

Already registered? Your username and password were emailed when you first applied.

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Automated Email Confirmation
Temporary Inbox · Demo Mode

Upon submission, an encrypted confirmation docket is automatically dispatched to your email on file. In demo mode the system generates a mock preview inbox so you can see the exact confirmation patients receive.

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    From: protocol@pri-domestic.mil
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    Subject: PRI Confirmation · [DOCKET-ID]
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    Signed: Patriot Regeneration · Classified S/MIME
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    Attachment: Docket PDF + next-step instructions
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What happens after you submit
4-step accession pipeline

  1. Confirmation issued

    Your docket ID appears on the next screen together with the amount due for your tier. Copy the ID for your records.

  2. Complete your tier payment

    You continue straight to the payment page, which shows the exact amount and the refund terms before anything is charged.

  3. Receipts issued

    A payment receipt and your docket confirmation are dispatched to your email on file. Retain both.

  4. Intake review

    Our intake team reviews your file, confirms eligibility and contacts you to answer questions and arrange your assessment.

Secure Contact · 24/7
📞 +1 (800) 555-0147
Secure Switchboard · 06:00–22:00 ET
📧 protocol@pri-domestic.mil
📍 Andrews Annex · Bldg. 41
Joint Base Andrews · MD