Curo Health Services, LLC

Mailed: November 19, 2025
UNITED STATES PATENT AND TRADEMARK OFFICE
Trademark Trial and Appeal Board
————
In re Curo Health Services, LLC
————
Serial No. 98414104
————
Michele M. Glessner of Moore & Van Allen LLP,
for Curo Health Services, LLC.
Dylan Marie Reynolds, Trademark Examining Attorney, Law Office 130,
John Lincoski, Managing Attorney.
————
Before Wellington, Lebow, and Allard,
Administrative Trademark Judges.
Opinion by Wellington, Administrative Trademark Judge:
Curo Health Services, LLC (“Applicant”) seeks registration on the Principal
Register of the standard character mark ILLUMIA HEALTH for “palliative care
services; hospice services; home health care services,” in International Class 44.1 The
term HEALTH has been disclaimed.
1 Application Serial No. 98414104, filed February 21, 2024, based on Applicant’s allegation of
a bona fide intent to use the mark in commerce under Trademark Act Section 1(b), 15 U.S.C.
§ 1051(b).
THIS OPINION IS NOT A
PRECEDENT OF THE TTAB

Serial No. 98414104
2
The Trademark Examining Attorney refused registration of Applicant’s mark
under Trademark Act (“the Act”) Section 2(d), 15 U.S.C. § 1052(d), on the ground of
likelihood of confusion, citing two registrations for the mark ILLUMINA, owned by
the same registrant:
Registration No. 6511719 (“Reg. ’719”) covers various services in different classes,
including “research services, namely, case studies in the fields of and for use in
the fields of … medical diagnostics, … clinical diagnostics, medical research, …
clinical research, drug development, drug development research, medical
laboratory research” in Class 42, and “medical testing for diagnostic or treatment
purposes,” in Class 44;2 and
Registration No. 6860132 (“Reg. ’132”) covers various services in different classes,
including “medical services,” in Class 44.3
After the Examining Attorney made the refusal final, Applicant appealed and
requested reconsideration, which the Examining Attorney denied. The appeal then
resumed and both Applicant and the Examining Attorney filed briefs. For the reasons
explained below, we affirm the refusal.
I. Likelihood of Confusion
Section 2(d) of the Act, in relevant part, prohibits registration of a mark that “so
resembles a mark registered in the Patent and Trademark Office … as to be likely,
when used on or in connection with the [services] of the applicant, to cause confusion.”
15 U.S.C. § 1052(d). To determine whether confusion is likely, we analyze all
probative evidence relevant to the factors set out in In re E. I. du Pont de Nemours &
2 Registration issued on October 5, 2021.
3 Registration issued on September 27, 2022.

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3
Co., 476 F.2d 1357, 1361 (CCPA 1973) (“DuPont”).4 See In re Majestic Distilling Co.,
315 F.3d 1311, 1315 (Fed. Cir. 2003).
In every Section 2(d) case, two key DuPont factors are the similarity or
dissimilarity of the marks and the relatedness of the respective goods or services,
because the “fundamental inquiry mandated by § 2(d) goes to the cumulative effect
of differences in the essential characteristics of the goods [or services] and differences
in the marks.” Federated Foods, Inc. v. Fort Howard Paper Co., 544 F.2d 1098, 1103
(CCPA 1976). Here, we have considered each DuPont factor that is relevant and for
which there is evidence and argument of record. See In re Guild Mortg. Co., 912 F.3d
1376, 1379 (Fed. Cir. 2019).
Varying weight may be assigned to each DuPont factor depending on the evidence
presented. See Citigroup Inc. v. Cap. City Bank Grp. Inc., 637 F.3d 1344, 1356 (Fed.
Cir. 2011); In re Shell Oil Co., 992 F.2d 1204, 1206 (Fed. Cir. 1993) (“[T]he various
evidentiary factors may play more or less weighty roles in any particular
determination.”). Ultimately, however, “[e]ach case must be decided on its own facts
and the differences are often subtle ones.” Indus. Nucleonics Corp. v. Hinde, 475 F.2d
1197, 1199 (CCPA 1973).
4 Citations in this opinion adhere to the guidance in the TRADEMARK TRIAL & APPEAL BOARD
MANUAL OF PROCEDURE (TBMP) § 101.03 (June 2025). The TTABVUE citations in this
opinion refer to the Board’s docket system. The number preceding the TTABVUE designation
is the docket entry number and any numbers following indicate the page numbers within the
docket entry. The Trademark Status and Document Retrieval (TSDR) citations refer to the
USPTO’s electronic file database for the involved application.

Serial No. 98414104
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We focus our likelihood of confusion analysis on the cited Reg. ’132, rather than
Reg. ’719. We do so because Reg. ’132 covers “medical services,” a broad term not
found in Reg. ’719, and it presents a stronger basis for finding confusion. See Sock It
to Me v. Fan, No. 91230554, 2020 TTAB LEXIS 201, at *20-21 (confining likelihood
of confusion analysis to most similar pleaded mark); In re Max Cap. Grp. Ltd., No.
77186166, 2010 TTAB LEXIS 1, at *5 (same as to cited registration). If we find there
is a likelihood of confusion based on Reg. ’132, there is no need for us to consider
likelihood of confusion based on Reg. ’719. On the other hand, if no confusion is likely
based on Reg. ’132, then we would not find confusion likely based on Reg. ’719. Sock
it to Me, 2020 TTAB LEXIS 201 at *21. We therefore refer to Reg. ’132 as the cited
registration and basis for refusal in this decision.
A. Alleged Weakness of Registered Mark ILLUMINA
Before evaluating the similarity of the marks, we address Applicant’s assertion
that the cited mark, ILLUMINA, is weak based on “seventeen active third-party
registrations that share the same ‘dominant’ syllable as that in the Cited Marks, i.e.,
marks beginning with ILLUM- or ILLUMI-, registered based on use on the Principal
Register by different owners for healthcare related services in Class 44 that are
substantially similar to those associated with the [cited registered ILLUMINA
mark].”5 Applicant argues that these “coexisting registrations demonstrate that
consumers are already conditioned to differentiate between similar marks for
5 6 TTABVUE 8, referring to a list and copies of third-party registrations Applicant attached
to its November 30, 2024 Office Action response.

Serial No. 98414104
5
relevant healthcare services—and, therefore, the sources from which the subject
services are offered—based on even small differences in the marks.”6 Applicant also
relies on the Board’s decision in Carefirst of Md., Inc. v. FirstHealth of the Carolinas,
Inc., No. 91116355, 2005 TTAB LEXIS 600.
In determining strength or weakness of a mark, we look to see how it is regarded
by consumers, both conceptually and commercially.7 In re Chippendales USA, Inc.,
622 F.3d 1346, 1353-54 (Fed. Cir. 2010) (“A mark’s strength is measured both by its
conceptual strength ... and its marketplace strength ....”). “[T]he strength of a mark
is not a binary factor” and “varies along a spectrum from very strong to very
weak.” Juice Generation, Inc. v. GS Enters. LLC, 794 F.3d 1334, 1340 (Fed. Cir.
2015) (internal citations omitted). See also Palm Bay Imps., Inc. v. Veuve Clicquot
Ponsardin Maison Fondée en 1772, 396 F.3d 1369, 1375 (Fed. Cir. 2005) (quoting In
re Coors Brewing Co., 343 F.3d 1340, 1344 (Fed. Cir. 2003)).
Under the sixth DuPont factor, we consider “[t]he number and nature of similar
marks in use on similar goods [or services].” DuPont, 476 F.2d at 1361. Thus, a party
such as Applicant in this case may adduce such probative evidence and demonstrate
that a cited mark, or element thereof, has less source-identifying significance.
“Evidence of third-party use of similar marks on similar goods [or services] is relevant
6 6 TTABVUE 9.
7 The fifth DuPont factor involves a consideration of any “fame of the prior mark (sales,
advertising, length of use).” DuPont, 476 F.2d at 1361. This factor is usually neutral in ex
parte appeals because the owner of a cited mark is not a party to the appeal, and the
Examining Attorney is under no obligation to demonstrate the strength of the cited mark. In
re Integrated Embedded, No. 86140341, 2016 TTAB LEXIS 470, at *26. Therefore, we
consider the fifth factor to be neutral.

Serial No. 98414104
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to show that a mark is relatively weak and entitled to only a narrow scope of
protection.” Apex Bank v. CC Serve Corp., _ F.4th _ , 2025 U.S. App. Lexis 24802, at *6
(Fed. Cir. Sept. 25, 2025) (quoting Palm Bay, 396 F.3d at 1373). “When a field is
crowded with similar marks, the theory is that customers will be more adept at
distinguishing marks from each other and are less likely to be confused by similar
marks.” Id. (citing Juice Generation, 794 F.3d at 1338). In other words, sufficient
probative evidence may indicate that consumers are conditioned to distinguish
between marks based on otherwise less significant differences between the marks.
As to the seventeen third-party registrations Applicant submitted, we must point
out that these are not actually “evidence of third-party use of the registered marks in
the marketplace, for purposes of the sixth du Pont factor.” In re Davey Prods. Pty Ltd.,
No. 77029776, 2009 TTAB LEXIS 524, at *22 (citing Olde Tyme Foods Inc. v. Roundy’s
Inc., 961 F.2d 200, 203-04 (Fed. Cir. 1992)); see also AMF Inc. v. Am. Leisure Prods.,
Inc., 474 F.2d 1403, 1406 (CCPA 1973) (“The existence of these registrations is not
evidence of what happens in the market place or that customers are familiar with
them nor should the existence on the register of confusingly similar marks aid an
applicant to register another likely to cause confusion, mistake or to deceive.”).
Moreover, many of these registrations offer little insight as to any weakness in the
cited mark, ILLUMINA, because they either cover unrelated services or the marks
are dissimilar. See Omaha Steaks Int’l v. Greater Omaha Packing Co., 908 F.3d 1315,
1325 (Fed. Cir. 2018) (error to rely on third-party evidence of similar marks for
dissimilar goods, as Board must focus “on goods shown to be similar”); Specialty

Serial No. 98414104
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Brands, Inc. v. Coffee Bean Distribs., Inc., 748 F.2d 669, 675 (Fed. Cir. 1984) (noting
that none of third-party registrations submitted to show the number and nature of
similar marks on similar goods had the same format or conveyed a similar commercial
impression as the marks at issue). Of the third-party registrations, we find the
following to be most relevant:8
• ILLUME FERTILITY and 9
(owned by same registrant, FERTILITY disclaimed)
For: medical services mainly in the field of reproduction and fertility
• ILLUMIDENT10
For: medical information in the field of oral health care
• ILLUMINATE and ILLUMINATE PLASTIC SURGERY11
(owned by same registrant, PLASTIC SURGERY disclaimed)
For: cosmetic surgery services
• ILLUMIN812
For: chiropractic services
Although we do not completely discount the remaining third-party registrations,
they have less probative value because, again, they are for unrelated services or the
marks are dissimilar.13
8 Copies of registrations attached to Applicant’s response filed Nov. 30, 2024, at TSDR 143-
159.
9 Reg. Nos. 7208693 and 7197386.
10 Reg. No. 7111685.
11 Reg. Nos. 6472278 and 5664385.
12 Reg. No. 4934079.
13 These are: Reg. No. 7434339 (ILLUME for teeth whitening services); Reg. No. 6293927
(ILLUMENTAL for psychiatric services); Reg. No. 6997294 (ILLUME PSYCHOTHERAPY
and design, PSYCHOTHERAPY disclaimed, for psychodynamic and behavioral cognitive

Serial No. 98414104
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It is also worth addressing the Carefirst decision, not only because Applicant relies
upon it, but also because it offers insight as to when marks, or elements of marks,
have a demonstrated weakness in the health care or medical services fields.
Specifically, in that case, the Board found no likelihood of confusion exists between
the marks CAREFIRST and FIRSTCAROLINACARE based on a record that included
“evidence of substantial use of ‘care’ and ‘first’ marks and names in the healthcare
field.” Carefirst, 2005 TTAB LEXIS 600, at *59. The evidence included “testimony
from twelve third parties that use marks or names comprising, in part, the words
‘care’ and/or ‘first’ in the healthcare field.” Id. at *60. The Board also recognized that
“the words ‘care’ and ‘first’ are commonly used words with readily recognizable
meanings,” and with respect to the former term, CARE, “[o]ne can hardly adopt a
more highly descriptive/generic term in the healthcare field.” Id. at *61, 63. Based on
the record in that case, the Board determined that “the mere commonality of ‘first’
and ‘care’ in the parties’ marks (moreover, in the reverse order) is an insufficient basis
on which to find likelihood of confusion.” Id. at *65.
The record and circumstances involving the weakness of the cited mark in this
appeal bears little resemblance to those in Carefirst. Here, Applicant has adduced
therapy services); Regs. Nos. 6044151 and 6044164 (ILLUMINATING STORIES and
ILLUMINATIONS STORIES HEART-CENTERED HEALING FOR WHOLENESS and
design, HEART CENTERED HEALING disclaimed, both owned by same registrant and
covering energy healing services, namely, quantum transformation and healing services);
Reg. No. 5738043 (ILLUMINATING THE PATH TO BETTER HEALTH for health
information services); Reg. No. 5686398 (ILUM INSIGHT for medical information and
consultation in fields of disease management and clinical medical management); Reg. No.
5702311 (ILUMAFORMA for plastic surgery services); and Reg. Nos. 6019469 and 5765023
(ILUMYA SUPPORT and ILUMYA SUPPORT LIGHTING THE WAY, disclaimer of
SUPPORT, for patient support in connection with pharmaceutical services).

Serial No. 98414104
9
few third-party registrations for marks that are similar to Registrant’s ILLUMINA
mark and are for related services. We do not have “evidence of substantial use” of the
mark, ILLUMINA, or similar marks.
Also, in contrast to the nature of the prior mark in Carefirst, CAREFIRST, there
is no evidence demonstrating that the cited mark ILLUMINA, or any component part
thereof, has any particular meaning in connection with Registrant’s or Applicant’s
services. Indeed, Registrant’s mark issued on the Principal Register without any
requirement for a showing of acquired distinctiveness in whole or in part under
Section 2(f) of the Act, and is thus presumed to be inherently distinctive. See Tea Bd.
of India v. Republic of Tea, Inc., No. 91118587, 2006 TTAB LEXIS 330, at *62 (a
“mark that is registered on the Principal Register is entitled to all Section 7(b)
presumptions including the presumption that the mark is distinctive and moreover,
in the absence of a Section 2(f) claim in the registration, that the mark is inherently
distinctive for the goods.”).
In sum, the record shows, at best, only a slight weakness in marks beginning with
the letters ILLUM- in connection with medical care services, and this is weighed into
our analysis involving the similarity of the marks and ultimately our conclusion
whether there is likelihood of confusion. Accordingly, the sixth DuPont factor weighs
slightly against likelihood of confusion.
B. Comparison of the Marks
We turn now to the first DuPont factor, which focuses on the similarity or
dissimilarity of the marks in their entireties as to appearance, sound, connotation,
and commercial impression. See Palm Bay, 396 F.3d at 1371 (quoting DuPont, 476

Serial No. 98414104
10
F.2d at 1361). Similarity as to any one of these elements may be sufficient to support
a finding that the marks are confusingly similar. See Krim-Ko Corp. v. Coca-Cola Co.,
390 F.2d 728, 732 (CCPA 1968) (“It is sufficient if the similarity in either form,
spelling or sound alone is likely to cause confusion.”); In re Inn at St. John’s, LLC,
No. 87075988, 2018 TTAB LEXIS 170, at *13.
Applicant’s mark, ILLUMIA HEALTH, and the cited mark, ILLUMINA, are
extremely similar in appearance and sound because the first term of Applicant’s mark
and the registered mark are almost identical, with the only difference being the
addition of the penultimate letter N in the registered mark. Indeed, the addition or
omission of the letter N may easily go unnoticed visually. Consumers encountering
one mark in one setting, are unlikely to notice whether the letter N is present or not
upon encountering the other mark in a different setting.
We also point out, as often observed, that it is the first element of a mark that
tends to play a dominant role in the mark’s commercial impression. See In re Detroit
Ath. Co., 903 F.3d 1297, 1303 (Fed. Cir. 2018) (finding “[t]he identity of the marks’
initial two words is particularly significant because consumers typically notice those
words first”); Palm Bay, 396 F.3d at 1372-73; Presto Prods., Inc. v. Nice-Pak Prods.
Inc., No. 74797, 1988 TTAB LEXIS 60, *8 (TTAB 1988) (“it is often the first part of a
mark which is most likely to be impressed upon the mind of a purchaser and
remembered”). Thus, while the Board may not dissect marks for comparison, finding
that the first term in a mark is the most distinctive in both placement and connotation
is entirely permissible. See In re Nat’l Data Corp., 753 F.2d 1056, 1058 (Fed. Cir. 1985)

Serial No. 98414104
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(“[T]here is nothing improper in stating that, for rational reasons, more or less weight
has been given to a particular feature of a mark, provided the ultimate conclusion
rests on consideration of the marks in their entireties.”). Here, the disclaimed word
HEALTH is highly descriptive or generic for Applicant’s health care services and, as
such, it is much less likely to have source-identifying impact in the minds of
consumers. See Detroit Ath., 903 F.3d at 1303 (citing In re Dixie Rests., Inc., 105 F.3d
1405, 1407 (Fed. Cir. 1997)) (disclaimed matter that is descriptive of or generic for a
party’s goods is typically less significant or less dominant when comparing marks).
Applicant argues that the marks will be pronounced differently:14
The first word in Applicant’s Mark, ILLUMIA, is pronounced “ill-oom-ee-
uh.” The letter added to the Cited Marks results in a significantly different
pronunciation of the Cited Marks, specifically, “ill-oom-in-uh.” The likely
pronunciations of Applicant’s Mark and the Cited Marks are indisputably
different, which supports a finding that the marks are distinguishable and
not confusingly similar. Moreover, inclusion of the “N” immediately calls to
mind the word “illuminate,” further differentiating Applicant’s Mark from
the Cited Marks.
We disagree that ILLUMIA and ILLUMINA will necessarily be pronounced so
differently so as to distiguish the marks aurally and avoid a likelihood of confusion.
Also, as we often point out and as explained by the U.S. Court of Appeals for the
Federal Circuit in Stoncor Grp., Inc. v. Specialty Coatings, Inc., 759 F.3d 1327, 1331-
32 (Fed. Cir. 2014), “there is no correct pronunciation of a trademark that is not a
recognized word.” Accord Chas. Pfizer & Co., Inc. v. R. J. Moran Co., 1960 TTAB
LEXIS 105, at *4 (no number in original) (finding that DIABINESE and DIABLAISE
14 6 TTABVUE 7. In support, Applicant cites to Internet evidence attached to its Request for
Reconsideration, filed February 15, 2025.

Serial No. 98414104
12
“when spoken are substantially similar in sound” because “[t]here is no correct
pronunciation of a mark” where the marks are “coined marks having no specific
meaning and no established pronunciation”). In other words, this principle may apply
to instances involving an invented term devoid of any known or understood meaning.
See, e.g., Inter Ikea Sys. B.V. v. Akea, LLC, No. 9119652, 2014 TTAB LEXIS 166, at
*20 (finding IKEA and AKEA confusingly similar, where “both marks are coined
terms that look alike and sound alike” with “no apparent meaning in any language”).
Here, both ILLUMIA and ILLUMINA comprise four syllables, and should the first
two syllables be accentuated in both terms, the letter N may be less accentuated and
go unnoticed to the ear.
In terms of meaning, ILLUMIA and ILLUMINA have no defined meanings. With
regard to Applicant’s argument that the “inclusion of the N [in the registered mark]
immediately calls to mind the word ‘illuminate,’ further differentiating [the marks],”
we disagree that this is a point of difference that helps distinguish the marks in terms
of meaning. Rather, both marks are likely to be perceived by consumers as suggestive
of the words “illume” or “illuminate,” which have the same meaning – to light up. In
other words, both marks may conjure the similar meaning that has no demonstrated
significance in connection with the services.
In sum, we conclude that the marks ILLUMIA HEALTH and ILLUMINA are
overall very similar. Accordingly, the first DuPont factor weighs in favor of a
conclusion that confusion is likely.

Serial No. 98414104
13
C. Legal Identity of the Services and Channels of Trade
We turn now to the second and third DuPont factors, which concern the
relatedness of the services and the channels of trade for the services. DuPont, 476
F.2d at 1361. In this analysis, we must consider the services as they are identified in
Applicant’s application and the cited registration. See Stone Lion Cap. Partners, L.P.
v. Lion Cap. LLP, 746 F.3d 1317, 1323 (Fed. Cir. 2014) (quoting Octocom Sys., Inc. v.
Houston Comp. Servs. Inc., 918 F.2d 937, 942 (Fed. Cir. 1990)). Further, it is sufficient
for a finding of likelihood of confusion as to a class of services in the application if
relatedness is established for any one of the recited services within the registration.
Tuxedo Monopoly, Inc. v. Gen. Mills Fun Grp., 648 F.2d 1335, 1336 (CCPA 1981).
Finally, and relevant to this appeal, we must give a full sweep to the recitations of
services in both the application and cited registration. See S.W. Mgmt., Inc. v.
Ocinomled, Ltd., No. 94002242, 2015 TTAB LEXIS 176, *60-61 (where the goods or
services in an application or registration are broadly described, they are deemed to
encompass all the goods or services of the nature and type described therein) (citation
omitted); In re Hughes Furniture Indus., Inc., No. 85627379, 2015 TTAB LEXIS 65,
*10 (“Applicant’s broadly worded identification of ‘furniture’ necessarily encompasses
Registrant’s narrowly identified ‘residential and commercial furniture.’”).
Here, Applicant’s services are “palliative care services; hospice services; home
health care services,” and the Registrant’s services include “medical services.”
We agree with the Examining Attorney that the cited registration “uses broad
wording … ‘medical services,’ which encompasses … Applicant’s more narrow

Serial No. 98414104
14
‘palliative care services,’ ‘hospice services,’ and ‘home health care services.’”15 Indeed,
the adjective “medical” is defined as “of, relating to, or concerned with physicians or
the practice of medicine,” and this is broad enough to describe services such as
“palliative care” services (to palliate is defined as “to reduce the violence of a disease”)
and “health care” services (defined as “efforts made to maintain, restore, or promote
someone’s physical, mental, or emotional well-being especially when performed by
trained and licensed professionals.”).16
As to the channels of trade, we must presume that these legally identical services
will be the same. In re Viterra Inc., 671 F.3d 1358, 1362 (Fed. Cir. 2012) (even though
there was no evidence regarding channels of trade and classes of consumers, the
Board was entitled to rely on this legal presumption in determining likelihood of
confusion); see also Genesco Inc. v. Martz, No. 121296, 2003 TTAB LEXIS 123, at *28
(“Given the in-part identical and in-part related nature of the parties’ goods, and the
lack of any restrictions in the identifications thereof as to trade channels and
purchasers, these clothing items could be offered and sold to the same classes of
purchasers through the same channels of trade.”).
15 8 TTABVUE 13.
16 We take judicial notice of the definitions of the terms “medical” and “palliate” and “health
care” from the online version of THE MERRIAM-WEBSTER DICTIONARY. MERRIAM-
WEBSTER.COM DICTIONARY, Merriam-Webster, https://www.merriam-webster.com/dictionary.
Accessed 11 Nov. 2025. See Univ. of Notre Dame du Lac v. J. C. Gourmet Food Imports Co.,
1982 TTAB LEXIS 146, at *7 (“[T]he Board may take judicial notice of use of a term in
dictionaries.”). See also B.V.D. Licensing Corp. v. Body Action Design Inc., 846 F.2d 727, 728
(Fed. Cir. 1988) (“dictionaries and encyclopedias may be consulted”). See also In re Zuma
Array Ltd., No. 79288888, 2022 TTAB LEXIS 281, at *15 n.18.

Serial No. 98414104
15
Given the in-part legally identical services, and that the trade channels are the
same for these legally identical services, the second and third DuPont factors strongly
favor a likelihood of confusion.
Despite the above findings and conclusions regarding the second and third
DuPont factors, we address Applicant’s arguments that its services are significantly
different from those offered by the Registrant. Specifically, Applicant contends that
it and Registrant “offer their services in different sectors of the healthcare industry
[and] also offer their services to different consumers in the industry.”17 Applicant
asserts that based upon “a careful reading of the identifications of services in the
Cited Registrations, it can be readily understood that the registrant offers its services
for medical testing and diagnostics to healthcare providers, such as doctors and their
practices, hospitals, scientists, and the like, as only trained medical professionals and
scientists would order and perform medical diagnostics and treatment.”18 Applicant
further asserts that “[c]onversely, Applicant’s palliative care, hospice, and home
health care services are targeted to end-consumers, such as elderly citizens and/or
family members making healthcare choices for their elderly loved ones.”19 Applicant
also submitted printouts from Registrant’s website to support its contention that
“Registrant’s target consumers, healthcare providers and scientists, are highly
17 6 TTABVUE 21.
18 6 TTABVUE 21.
19 6 TTABVUE 21.

Serial No. 98414104
16
trained and sophisticated medical professionals and providers that are subject to
strict government regulation and standards of care.”20
Applicant’s argument, however, is unavailing because it ignores the fact that
Registrant’s “medical services” are separated by a semicolon from the other services
listed in the registration and, as such, constitutes a distinct service that is not
construed or limited based on the remaining services listed in the registration’s
recitation of services. See, e.g., In re Midwest Gaming & Entm’t LLC, No. 85111552,
2013 TTAB LEXIS 55, at *9 & n.4 (semicolons in identification separate services into
discrete categories). In addition, to the extent that Applicant is relying on the
Registrant’s website to confine or narrow the scope of Registrant’s services, as they
are described in the registration, this is improper because we cannot rely on extrinsic
evidence of actual use to limit the cited registration’s recitation of services. See In re
i.am.symbolic, llc, 866 F.3d 1315, at 1323-1325 (Fed. Cir. 2017); Octocom Sys., 918
F.2d at 943.
Although not necessary for our decision, the record also includes the Examining
Attorney’s submission of Internet evidence showing a relationship between
Registrant’s medical testing and diagnostic services21 and Applicant’s palliative,
hospice and home health care services.22 In all, the Examining Attorney submitted
20 Applicant’s response filed November 30, 2024, with website printouts attached as Exs. A-1
and A-2.
21 Specifically, Reg. ’132 lists “medical testing and analysis for diagnostic or treatment pur-
poses,” as well as more specific testing and diagnostic services in the fields such DNA and
genome sequencing.
22 Internet evidence attached to Office Actions issued on January 13, 2025 and April 8, 2025.

Serial No. 98414104
17
printouts from thirteen different websites for entities that provide these services –
e.g., the Johns Hopkins advertises “palliative care, hospice care” and “Johns Hopkins
Care at Home brings health care services to you,” while also touting its “Testing
Services … Genetic Resources Core Facility … DNA Diagnostic Laboratory.”23 This
evidence is probative because it shows that these are the types of services that may
emanate from a common source under a single mark. See Detroit Athletic, 903 F.3d
at 1306 (evidence that third parties use the same mark for the involved goods and
services “suggests that consumers are accustomed to seeing a single mark associated
with a source that sells both”); Hewlett-Packard Co. v. Packard Press, Inc., 281 F.3d
1261, 1267 (Fed. Cir. 2002) (stating that evidence that “a single company sells the
goods and services of both parties, if presented, is relevant to a relatedness analysis”);
In re Davey Prods. Pty Ltd., 2009 TTAB LEXIS 524, at *14-15 (third-party website
evidence shows that the applicant’s and registrant’s products “can be manufactured
and sold by a single source”).
Accordingly, in addition to our finding that Applicant’s palliative, hospice and
home health care services are legally identical to Registrant’s “medical services,” we
find Applicant’s services are closely related to Registrant’s medical testing and
diagnostic services.
D. Consumer Sophistication
Under the fourth DuPont factor, we consider “[t]he conditions under which and
buyers to whom sales are made, i.e. ‘impulse’ vs. careful, sophisticated purchasing.”
23 January 13, 2025 Office Action, TSDR pp. 32-44.

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DuPont, 476 F.2d at 1361. As a general matter, “we must make our determination
based on the least sophisticated consumer.” In re Guild Mortg. Co., No. 86709944,
2020 TTAB LEXIS 17, at *17 (citing Stone Lion, 746 F.3d at 1325); In re FCA US LLC,
No. 85650654, 2018 TTAB LEXIS 116, at *29.
In this regard, Applicant argues that “although Applicant’s services are offered to
the general public, such consumers are still more prudent than the average purchaser
because they exercise great care in selecting palliative care, hospice, and home health
care services.”24 Applicant also argues that “Registrant’s consumers must carefully
select providers of services for medical diagnostics and treatment, as making correct
and accurate diagnoses is crucial to providing effective and safe medical care” and
that they are “thus necessarily sophisticated and make prudent purchasing decisions
such that they are not likely to be confused.”25
The Examining Attorney responds by stating that, “[a]ssuming arguendo that the
consumers are sophisticated, it is settled that ‘even sophisticated purchasers are not
immune from source confusion,’” citing and quoting the Board’s decision in In re
i.am.symbolic, 2015 TTAB LEXIS 369, at *21.26 The Examining Attorney further
argues that any presumed sophisticated purchasing decision is outweighed by the
“identity of the marks and the relatedness of the … services.”27 We agree.
24 6 TTABVUE 23.
25 6 TTABVUE 22.
26 8 TTABVUE 20.
27 8 TTABVUE 20. As Applicant aptly points out, the marks in this appeal are not identical.

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In certain cases, the Board has found that the fourth DuPont factor supports a
finding that confusion is not likely due to the importance of, and other circumstances
surrounding, decisions to purchase services regarding living conditions, health care
and medical services. See, e.g., Primrose Retirement Cmtys., LLC v. Edward Rose
Senior Living, LLC, No. 91217095, 2016 TTAB LEXIS 604, at *28 (higher level of care
in “decision regarding a senior living community is a serious one, often a once-in-a-
lifetime choice, and one that is relatively expensive”). Consumers of Applicant’s
palliative, hospice and home health care services, and those interested in Registrant’s
“medical services” are from the general public and they likely would not be uniformly
sophisticated. Nevertheless, as explained in Primrose, because all of these services
involve decisions concerning personal health and well-being, and may involve
considerable expense, even the least sophisticated potential purchaser is likely to
exercise more than ordinary care in selecting and obtaining the services. In other
words, these are inherently the types of services where consumers generally will take
more time in selecting the source or provider of the services.
We find that the fourth DuPont factor slightly supports a finding that confusion is
not likely.
II. Conclusion
The first DuPont factor favors a finding of a likelihood of confusion because
Applicant’s mark ILLUMIA HEALTH and the cited mark ILLUMINA are very
similar. The second and third DuPont factors strongly support such a finding because
the involved services and channels of trade are legally identical in part.

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On the other hand, both the fourth and sixth DuPont factors slightly support a
finding that confusion is not likely given the inherent personal importance of the
services to consumers, and there being some weakness in ILLUM- formative marks
for medical-related services.
In weighing the relative importance of these factors, we conclude that “the legal
identity in part and similarity of the services and the similarity between the marks
outweigh any sophisticated purchasing decision.” Integrated Embedded, 2016 TTAB
LEXIS 470, at *41. “In view thereof, we find that Applicant’s mark, as used in
association with the services identified in the application, is likely to cause confusion
with the registered mark used in connection with the services recited in the
registration.” Id. at 41.
Decision: The refusal under Trademark Act Section 2(d) to register ILLUMIA
HEALTH is affirmed.