Jutiso Inc.

This Opinion is Not a
Precedent of the TTAB
Mailed: June 4, 2026
UNITED STATES PATENT AND TRADEMARK OFFICE
_____
Trademark Trial and Appeal Board
_____
In re Jutiso Inc.
_____
Serial No. 90828203
_____
Catherine M.C. Farrelly, Jean Voutsinas, and Francesca Campione of Frankfurt
Kurnit Klein & Selz PC, for Jutiso Inc.
Danielle Anderson, Trademark Examining Attorney, Law Office 113,
Myriah Habeeb, Managing Attorney.
_____
Before Allard, Lavache and Bradley,
Administrative Trademark Judges.
Opinion by Bradley, Administrative Trademark Judge:
Jutiso Inc. (“Applicant”) applied to register the standard-character mark SEVEN
STARLING on the Principal Register for the following:
Providing classes, seminars, workshops, programs, and
training in the fields of pregnancy, childbirth, fertility,
preconception, conception, postpartum depression,
miscarriage and loss, parenting, menopause, and mental
health, in International Class 41; and

Serial No. 90828203
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Organizing, managing, and facilitating support groups in
the fields of pregnancy, childbirth, fertility, preconception,
conception, postpartum depression, miscarriage and loss,
parenting, menopause, and mental health, in International
Class 45.1
The Examining Attorney refused registration under Section 2(d) of the Trademark
Act, 15 U.S.C. § 1052(d), on the ground that Applicant’s mark is likely to cause
confusion with the standard character mark STARLING PHYSICIANS
(PHYSICIANS disclaimed) registered on the Principal Register for “medical services”
in International Class 44 (“Cited Registration”).2
1 Application Serial No. 90828203, filed on July 14, 2021, under Section 1(b) of the Trademark
Act, 15 U.S.C. § 1051(b), alleging Applicant’s bona fide intent to use the mark in commerce.
The Application also initially included “Medical services in the fields of pregnancy, childbirth,
fertility, preconception, conception, postpartum depression, miscarriage and loss, parenting,
menopause, and mental health; Breastfeeding counseling services; Doula services for birth
and postpartum, namely, experienced labor companion who provides people with emotional
and physical support throughout the entire labor, delivery and postpartum period” in Class
44, but Applicant deleted these services in its April 26, 2024 Response to Suspension Inquiry
at 2. Applicant explained that it deleted these services because “Applicant does not provide
medical care directly to consumers.” 8 TTABVUE 5; December 13, 2024 Request for
Reconsideration at 8.
Page references to the application file refer to the online database of the United States Patent
and Trademark Office’s (“USPTO”) Trademark Status & Document Retrieval (“TSDR”)
system. All citations to documents contained in the TSDR database are to the downloaded
.pdf versions of the documents.
Citations to appeal briefs and other materials in the appeal docket refer to TTABVUE, the
Board’s online docketing system. Specifically, the number preceding TTABVUE corresponds
to the docket entry number, and any number(s) following TTABVUE refer to the page
number(s) of the docket entry where the cited materials appear.
2 Registration No. 5049373, registered on September 27, 2016 and has been maintained.

Serial No. 90828203
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After the Examining Attorney issued the final refusal, Applicant appealed and
requested reconsideration.3 The Examining Attorney denied the request for
reconsideration.4 The appeal is fully briefed.5 We reverse the refusal to register.
I. Evidentiary Objection
The Examining Attorney objects to “a list of registrations containing the term
STAR” that Applicant included in its request for reconsideration and appeal brief,
and requests the Board disregard the third-party registrations.6 We agree with the
Examining Attorney that “[m]ere listings of registrations are not sufficient to make
the registrations of record.” In re Star Belly Stitcher, Inc., No. 85247730, 2013 TTAB
LEXIS 451, at *16 (TTAB 2013). However, the Examining Attorney did not object to
the list when Applicant first submitted it with its request for reconsideration, and
also did not inform Applicant that the list was insufficient.7 Instead, the Examining
Attorney affirmatively discussed the listed registrations both in its denial of
Applicant’s request for reconsideration and again in its appeal brief.8 We recognize
that given Applicant first submitted its list of registrations at a point where Applicant
could not correct the format of the submission, the Examining’s Attorney failure to
inform Applicant of the deficiency would normally not result in a waiver of any
3 1 TTABVUE.
4 4 TTABVUE.
5 8 TTABVUE (Applicant’s brief); 10 TTABVUE (Examining Attorney’s brief); 11 TTABVUE
(Applicant’s reply brief).
6 10 TTABVUE 3; December 13, 2024 Request for Reconsideration at 14-16; 8 TTABVUE 11-
13.
7 See December 13, 2024 Request for Reconsideration at 14-16; 4 TTABVUE 4.
8 4 TTABVUE 4; 10 TTABVUE 11-12.

Serial No. 90828203
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objection by the Examining Attorney. See In re Lorillard Licensing Co., LLC, No.
76680117, 2011 TTAB LEXIS 206, at *3 n.3 (TTAB 2011). Yet, we find that, here,
where the Examining Attorney both did not object, and affirmatively discussed the
list of registrations in its denial of Applicant’s request for reconsideration (and again
in its appeal brief despite its objection), that the Examining Attorney did waive the
objection. Cf. In re 1st USA Realty Professionals, Inc., No. 78553715, 2007 TTAB
LEXIS 73, at *3 (TTAB 2007) (“deem[ing] the Examining Attorney to have treated
this registration as being of record” where Examining Attorney addressed it “in both
his denial of the request for reconsideration and in his appeal brief”); see also
TRADEMARK TRIAL AND APPEAL BOARD MANUAL OF PROCEDURE (TBMP) § 1208.02
(2025) (“An improper listing of third-party registrations will not be considered if the
list is submitted at a point where the applicant cannot correct the format of the
submission and if the examining attorney does not discuss the registrations or
otherwise treat them as of record.”) (emphasis added).
Accordingly, we consider only the information included in Applicant’s list of third-
party STAR registrations “for whatever limited probative value such evidence may
have.” In re City of Houston, No. 77660948, 2012 TTAB LEXIS 1, at *5 (TTAB 2012)
(citation omitted).9
9 In response to the Examining Attorney’s objection in its appeal brief to the list of
registrations, Applicant filed copies of the third-party registrations with its reply brief. 11
TTABVUE 3-63. We do not consider these copies because such evidence is “manifestly
untimely” and the examining attorney had no “opportunity to examine the new evidence and
respond to it.” City of Houston, 2012 TTAB LEXIS 1, at *5 (citation omitted).

Serial No. 90828203
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II. Likelihood of Confusion
Our determination under Section 2(d) of the Trademark Act involves an analysis
of all of the probative evidence of record that is relevant to the factors bearing on a
likelihood of confusion. See In re E.I. DuPont DeNemours & Co., 476 F.2d 1357, 1361
(CCPA 1973) (“DuPont”); see also Palm Bay Imps., Inc. v. Veuve Clicquot Ponsardin
Maison Fondee En 1772, 396 F.3d 1369, 1371 (Fed. Cir. 2005).
We must consider “each DuPont factor for which there is evidence and argument.”
Spireon, Inc. v. Flex Ltd, 71 F.4th 1355, 1362 (Fed. Cir. 2023) (citing In re Guild
Mortg. Co., 912 F.3d 1376, 1380 (Fed. Cir. 2019)). “The weight given to each factor
depends on the circumstances of each case.” In re Charger Ventures LLC, 64 F.4th
1375, 1381 (Fed. Cir. 2023). “[A]ny one of the factors may control a particular case.”
Naterra Int’l, Inc. v. Bensalem, 92 F.4th 1113, 1116 (Fed. Cir. 2024) (citation omitted).
In any likelihood of confusion analysis, two key considerations are the similarities
between the marks and the similarities between the goods and services. See In re
i.am.symbolic, llc, 866 F.3d 1315, 1322 (Fed. Cir. 2017) (“likelihood of confusion
analysis considers all DuPont factors for which there is record evidence but ‘may focus
. . . on dispositive factors, such as similarity of the marks and relatedness of the
goods’”) (alteration in the original) (quoting Herbko Int’l, Inc. v. Kappa Books, Inc.,
308 F.3d 1156, 1164-65 (Fed. Cir. 2002)). These and other factors addressed by
Applicant and the Examining Attorney are discussed below.

Serial No. 90828203
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A. Strength or Weakness of Registrant’s Mark
Applicant contends that the Cited Registration for the mark STARLING
PHYSICIAN is “weak” and “entitled to only a limited zone of protection.”10 “There are
two prongs of analysis for a mark’s strength under the sixth [DuPont] factor:
conceptual strength and commercial strength.” See, e.g., Spireon, 71 F.4th at 1362.
We do not consider commercial strength here because Applicant has not provided any
evidence of third-party marketplace use. See New Era Cap Co. v. Pro Era, LLC, No.
91216455, 2020 TTAB LEXIS 199, at *36 (TTAB 2020) (“Applicant did not provide
evidence of any third-party use of marks consisting of or comprised of the term ERA
for these goods, and thus no evidence of commercial weakness.”).
Conceptual or inherent strength is a measure of a mark’s distinctiveness. In re
Chippendales USA, Inc., 622 F.3d 1346, 1353-54 (Fed Cir. 2010). Distinctiveness is
“often classified in categories of generally increasing distinctiveness[:] . . . (1) generic;
(2) descriptive; (3) suggestive; (4) arbitrary; or (5) fanciful.” Two Pesos, Inc. v. Taco
Cabana, Inc., 505 U.S. 763, 768 (1992). “The existence of third-party registrations on
similar goods [and services] can bear on a mark’s conceptual strength. Specifically,
third-party registrations containing an element that is common to both the [Cited
Registration] and [Applicant’s] mark[] can show that that element has a normally
understood and well-recognized descriptive or suggestive meaning.” Spireon, 71 F.4th
at 1363 (citations omitted). However, to do so, the third-party marks and services
generally must be as similar to the mark and services in the Cited Registration as is
10 8 TTABVUE 10, 13.

Serial No. 90828203
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Applicant’s mark and services. See, e.g., In re Mighty Leaf Tea, 601 F.3d 1342, 1347
(Fed. Cir. 2010) (“No additional evidence, or proffer, was presented to contravene the
Board’s finding that the third-party marks were not similar enough to the mark ML
to establish that there is a crowded field for the letters ‘ML.’”).
Applicant submitted evidence of six third-party registrations for the mark
STARLING (or that include the word STARLING in the mark) which Applicant
argues demonstrates that Applicant’s Mark and the Cited Registration can coexist on
the register.11 Initially, we eliminate one of Applicant’s third-party registrations from
consideration because it has been cancelled.12 See In re Kysela Pere et Fils, Ltd., No.
77686637, 2011 TTAB LEXIS 70, at *7 (TTAB 2011) (“‘dead’ or cancelled registrations
have no probative value at all”). Additionally, we find that four of the remaining
registrations lack probative value because the services covered in the third-party
registrations are different from the “medical services” covered by the Cited
Registration, and Applicant has not demonstrated that they are similar.13 See
11 8 TTABVUE 9-11; December 13, 2024 Request for Reconsideration at 27-33, 64-76.
12 Registration No. 5523709, December 13, 2024 Request for Reconsideration at 75-76; 10
TTABVUE 9.
13 Registration Nos. 5439391 (includes providing and operating various independent living
facilities, senior living communities, etc.), 5295197 (includes various managing, leasing, or
real estate development of senior living communities, apartments for seniors, independent
living communities, etc.), 4406376 (“real estate development”), and 7448979 (includes
“therapeutic summer camps for youth diagnosed with autism, neurodiversity and other
developmental disorders”). December 13, 2024 Request for Reconsideration at 65-74.
Applicant argues that senior living facilities and therapeutic summer camps “typically offer
medical services” respectively to members of the facilities and camp attendees. 8 TTABVUE
10. Yet, Applicant offers no evidence in support of its argument, and there are not any medical
services encompassed within the identifications of these third-party registrations. See Cai v.
Diamond Hong, Inc., 901 F.3d 1367, 1371 (Fed. Cir. 2018) (citation omitted) (“assertions of
fact” in a brief are “not evidence under any of the relevant rules”).

Serial No. 90828203
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i.am.symbolic, 866 F.3d at 1328 (Applicant “has neither introduced evidence, nor
provided adequate explanation to support a determination that the existence of . . .
marks for goods in other classes, . . . support a finding that [the cited] registrants’
marks are weak with respect to the goods identified in their registrations”). We do
consider the one remaining registration because it covers a similar mark, STARLING
in standard characters, and medical equipment which is similar to, and may be used
in the provision of the broad “medical services” in the Cited Registration.14 But this
one registration falls short of the “extensive evidence of third-party registrations”
required to demonstrate weakness. Jack Wolfskin Ausrustung Fur Draussen GmbH
& Co. KGaA v. New Millennium Sports, S.L.U., 797 F.3d 1363, 1373 (Fed. Cir. 2015).
Applicant also argues that “there are also a host of registered marks for medical
and healthcare services, which incorporate the overlapping syllable STAR, many of
which [are] in the first position of the mark, just like the Registered Mark.”15 As
14 Registration No. 4937214, December 13, 2024 Request for Reconsideration at 28-33. The
Examining Attorney argues that third-party Registration No. 4937214 is not relevant
because:
[A]pplicant’s services and the services in the [C]ited
[R]egistration are both marketed toward individuals seeking
medical information and treatment. The goods in Registration
No. 4937214 are marketed toward medical professionals and
hospitals. Thus, while the goods and services are both related to
the medical field in general, they are not marketed towards the
same consumers.
10 TTABVUE 11. However, the identification of goods in third-party Registration No.
4937214 includes various “cardiac output monitors” and “hemodynamic monitors” for “home
centered use” which includes the same individuals that would be seeking medical information
and treatment encompassed within the Cited Registration’s “medical services.” See December
13, 2024 Request for Reconsideration at 28.
15 8 TTABVUE 11-13.

Serial No. 90828203
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discussed above, we consider only the chart of 11 third-party registrations that
Applicant submitted. We find this list of third-party “STAR” formative marks lacks
probative value because “none of the[se] marks are as similar to the mark in the
[C]ited [R]egistration as is Applicant’s mark.” In re I-Coat Co., LLC, No. 86802467,
2018 TTAB LEXIS 171, at *16-17 (TTAB 2018).
We also consider where the Cited Registration is classified on the spectrum of
distinctiveness. Given that the Cited Registration is “prima facie evidence of the
validity of the registered mark,’’ see Section 7(b) of the Trademark Act, 15 U.S.C.
§ 1057(b), we must assume that Registrant’s mark STARLING PHYSICIANS is
inherently distinctive (i.e., at least suggestive), since it is registered on the Principal
Register without a claim of acquired distinctiveness under Section 2(f) of the
Trademark Act. See New Era, 2020 TTAB LEXIS 199, at *29-30. However, we do find
that the cited mark STARLING PHYSICIANS is suggestive of the “medical services”
in the Cited Registration and considered together with the disclaimed wording
PHYSICIANS results in some overall conceptual weakness. In particular Registrant’s
mark considered in relation to the “medical services” covered by the Cited
Registration “readily suggests” that Registrant provides physicians that offer medical
assistance. See Sports Auth. Mich., Inc. v. PC Auth., No. 91113785, 2002 TTAB LEXIS
65, at *66 (TTAB 2002).
Considering the evidence together, we find that the Cited Registration has some
conceptual weakness, and as a result a narrower scope of protection. See Bass Pro
Trademarks, L.L.C. v. Sportsman’s Warehouse, Inc., No. 92045000, 2008 TTAB

Serial No. 90828203
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LEXIS 16, at *38 (TTAB 2008) (“[I]t is well settled that when a mark, or a portion of
a mark, is inherently weak, it is entitled to a narrow scope of protection.”).
B. Similarity of the Marks
We evaluate “[t]he similarity or dissimilarity of the marks in their entireties as to
appearance, sound, connotation and commercial impression.” In re Detroit Ath. Co.,
903 F.3d 1297, 1303 (Fed. Cir. 2018) (citing DuPont, 476 F.2d at 1361).
Applicant’s mark is SEVEN STARLING and the cited mark is STARLING
PHYSICIANS. In our comparison of the marks, we keep in mind our determination
that the cited mark has some conceptual weakness and as such is entitled to a
narrower scope of protection.
At the outset, the Examining Attorney argues that “STARLING” is the dominant
term in both marks, and given this identity, “the marks create a similar overall
commercial impression, regardless of the inclusion of additional terms.”16 “It is well-
established that it is improper to dissect a mark, and that marks must be viewed in
their entireties.” Coach Servs. v. Triumph Learning LLC, 668 F.3d 1356, 1368 (Fed.
Cir. 2012); Juice Generation, Inc. v. GS Enters. LLC, 794 F.3d 1334, 1341 (Fed. Cir.
2015) (“It is the mark in its ‘entiret[y]’ that must be assessed.) (citing DuPont, 476
F.2d at 1361). However, “[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.” In re
Nat’l Data Corp., 753 F.2d 1056, 1058 (Fed. Cir. 1985).
16 10 TTABVUE 5-6.

Serial No. 90828203
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We agree that STARLING is the dominant term in the Cited Registration given
that “PHYSICIANS” is disclaimed as descriptive of the identified “medical services”
as well as the fact that STARLING is the first word in the mark. See Nat’l Data, 753
F.2d at 1058 (“[t]hat a particular feature is descriptive . . . with respect to the involved
goods or services is one commonly accepted rationale for giving less weight to a
portion of a mark”). However, we disagree with the Examining Attorney that
STARLING is dominant in Applicant’s mark SEVEN STARLING. SEVEN is an
arbitrary term as applied to the education and support group services identified in
Applicant’s application and thus conceptually strong. See Palm Bay, 396 F.3d at 1372
(“VEUVE is an arbitrary term as applied to champagne and sparkling wine, and thus
conceptually strong as a trademark.”).17 Additionally, SEVEN also has a prominent
position as the first term in the mark. See id. (“To be sure, CLICQUOT is an
important term in the mark, but VEUVE nevertheless remains a ‘prominent feature’
as the first word in the mark and the first word to appear on the label.”); see also
L’Oreal S.A. v. Marcon, No. 91184456, 2012 TTAB LEXIS 77, at *17 (TTAB 2012)
(“[P]urchasers in general are inclined to focus on the first word or portion in a
17 The Examining Attorney argues that SEVEN is not dominant, and “is not the more
significant term” because it is an adjective that “modifies the noun STARLING to indicate
the number of birds.” 10 TTABVUE 7. We do not think the status of SEVEN as a noun or
adjective controls whether the term is dominant. Additionally, the dictionary definition the
Examining Attorney submitted as evidence identifies “seven” as a noun, and the term
STARLING in Applicant’s mark is not plural thereby detracting from the Examining
Attorney’s argument that “seven” just describes the number of birds. See April 25, 2022 Office
Action at 10. As such we disagree that consumers would view SEVEN as insignificant and
merely modifying STARLING, especially given the lack of any relation of either term to the
Applicant’s identified services.

Serial No. 90828203
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trademark.”). Accordingly, we find that the words SEVEN and STARLING are
equally prominent in Applicant’s mark.
Considering overall appearance, while the marks share the word “STARLING,”
the structure of the marks differ with STARLING appearing first in the cited mark
STARLING PHYSICIANS and second in Applicant’s mark SEVEN STARLING. The
structure of the cited mark considered in relation to the “medical services” in the
Cited Registration conveys the name of a group of physicians offering medical
services, as discussed in more detail below. Additionally, the other words in the marks
“SEVEN” and “PHYSICIANS” are different and bear no relation to each other further
distinguishing the marks in overall appearance. See Heil Co. v. Tripleye GmbH, No.
91277359, 2024 TTAB LEXIS 494, at *76 (TTAB 2024) (marks look different overall
where even though they “share the term ‘eye’ . . . the first part of each mark is
different in at least sound and appearance: TRIPLE and THIRD”); Keystone Consol.
Indus. v. Franklin Inv. Corp., No. 92066927, 2024 TTAB LEXIS 290, at *86-87 (TTAB
2024) (“point of similarity between the marks is not sufficient to overcome the basic
dissimilarity in appearance and commercial impression when Respondent’s and
Petitioner’s marks are considered and compared in their entireties”).
With regards to sound, Applicant asserts that “Applicant’s Mark has a distinct
sound through the use of an alliterative linguistic device as both terms in the mark
start with an ‘S.’ The occurrence of the same letter and sound for each term in the
Applicant’s Mark creates a visually and aurally memorable, distinct mark.”18 The
18 8 TTABVUE 8.

Serial No. 90828203
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Examining Attorney responds that Applicant’s argument “is not supported by any
evidence and is not persuasive.”19 Yet, the evidence is Applicant’s mark itself, with
both words in the mark beginning with the letter “s”, and thus the same repeating
sound. This repetition is absent in the cited mark, and the other terms in the marks
“seven” and “physicians” sound completely different. See Carefirst of Md., Inc. v.
FirstHealth of the Carolinas, Inc., No. 91116355, 2005 TTAB LEXIS 600, at *53-54
(TTAB 2005) (“marks CAREFIRST and FIRSTCAROLINACARE do not sound alike”
where “applicant’s mark goes on to conclude in an alliterate manner with the words
‘Carolina’ and ‘care’”).
On connotation, Applicant argues that its mark SEVEN STARLING
“communicates a message of support, solidarity, and strength in numbers.”20 As
support, Applicant points to “[t]he significance of the number seven in relation to
Starling birds”21 and evidence it submitted showing that scientific research found
that:
[F]locking starlings strike an optimal balance between the
work of responding to social cues from their neighbors and
the need to conserve energy. This trade-off yields a special
number: seven. When starlings coordinate with their seven
nearest neighbors, they form their characteristic flocks
with the least effort.22
19 10 TTABVUE 6, 8.
20 8 TTABVUE 7.
21 Id.
22 September 30, 2022 Response to Office Action at 16 (article posted on Princeton
University’s website titled “Birds of a feather . . . track seven neighbors to flock together”).

Serial No. 90828203
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Building on this meaning, on its website under the headline “Why Seven Starling?”,
Applicant explains:
[S]tarlings always flock in groups. By following their seven
closest neighbors, starlings flock together to create
beautiful and mesmerizing formations in the sky called
murmurations. For us, these whimsical birds represent the
feeling of freedom and strength we hope to bring to our
community. A constant reminder that together, with our
flock, we can achieve a vision far greater than ourselves.23
The Examining Attorney argues that “[A]pplicant has not provided any evidence
to support the assertion that consumers will understand the wording SEVEN
STARLING as communicating this unique meaning by viewing the mark” and that
“use of the wording ‘to us’ emphasizes that this is [A]pplicant’s own interpretation,
not a generally recognized understanding of the wording SEVEN STARLING.”24 But,
Applicant’s meaning is based on specific facts about starling birds for which Applicant
provided supporting evidence. And even if consumers are not aware of these facts
about how starlings flock together in groups of seven, the Examining Attorney’s
evidence shows that “seven” is also defined as “something having seven units or
members,”25 and the “starling” definition the Examining Attorney submitted provides
the example of use as “a flock of starlings”.26 This evidence supports the meaning of
a group which when viewed in connection with Applicant’s services of educational
programs in fields such postpartum depression, miscarriage and loss, parenting and
23 September 30, 2022 Response to Office Action at 27.
24 10 TTABVUE 7.
25 April 5, 2022 Office Action at 10.
26 July 16, 2024 Final Office Action at 10-11.

Serial No. 90828203
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mental health as well as its support group services in similar fields, conveys a
message of support and/or strength in numbers. As Applicant argues, its mark “is
intended to evoke in consumers the feeling of freedom, such as is associated with
birds in flight, but also the solidarity that is associated in flying alongside others in
similar situations.”27 Such message is conveyed when considering the normal
meaning of the words in Applicant’s mark in relation to its services even if consumers
are not aware of the specific significance of “seven” to starling birds.
At the same time, Applicant submitted evidence showing that STARLING is a
surname28 and as such may “convey to consumers that STARLING is the surname of
one of the founding physicians associated with Registrant.”29 The Examining
Attorney does not address this evidence, but argues that “even if a consumer did view
the term STARLING in the registered mark as referring to . . . a surname, they would
view the identical term STARLING in [A]pplicant’s mark the same way.”30 Yet, this
argument ignores that the structure of the cited mark (i.e., [name] + descriptive term
physicians) is what conveys this meaning. This structure is absent in Applicant’s
Mark and therefore it does not convey the same meaning.
On commercial impression, we agree with Applicant that “Applicant’s Mark
[SEVEN STARLING] does not immediately indicate to the customer what the actual
27 8 TTABVUE 8.
28 December 13, 2024 Request for Reconsideration at 55.
29 8 TTABVUE 9.
30 10 TTABVUE 8.

Serial No. 90828203
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services it offers are.”31 Rather, “Applicant’s Mark sets the stage” expressing “the
supportive and warm nature of its brand, and invites the consumer to inquire more
about the services offered.”32 We also agree with Applicant that, in contrast, the cited
mark STARLING PHYSICIANS “plainly communicates the nature of the services
offered, medical services by a group of physicians” and “[a]s such, the mark leaves
consumers with a very different commercial impression.”33
Accordingly, even considering the general recollection of the average purchaser,
given the overall dissimilarity of the marks in sight, sound, meaning, and commercial
impression we find that this factor supports a finding of no likelihood of confusion.
C. Similarity of the Services, Channels of Trade, and Classes of
Consumers
Under the second and third DuPont factors, we analyze the “similarity or
dissimilarity and nature of the goods or services” and the similarity or dissimilarity
of trade channels and classes of consumers to whom, the Applicant’s and Registrant’s
services are marketed. DuPont, 476 F.2d at 1361; Stone Lion Cap. Partners, L.P. v.
Lion Cap. LLP, 746 F.3d 1317, 1322-23 (Fed. Cir. 2014). We must base our analysis
for both factors on “the applicant’s [services] as set forth in its application, and the
registrant’s [services] as set forth in its registration.” i.am.symbolic, 866 F.3d at 1325
(citation omitted); Detroit Ath., 903 F.3d at 1308 (third factor “must be evaluated with
an eye toward the channels specified in the application and registration”).
31 8 TTABVUE 8
32 Id.
33 Id. at 9.

Serial No. 90828203
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“[I]t is not necessary that the [services] of the parties be similar or even
competitive to support a finding of likelihood of confusion.” Coach Servs., 668 F.3d at
1369 (citation omitted). Rather, the question is whether the “respective [services] are
related in some manner and/or if the circumstances surrounding their marketing are
such that they could give rise to the mistaken belief that they emanate from the same
source.” Id. Put another way, the relevant inquiry is whether “consumers are
accustomed to seeing the applied-for and registered [services] originating from the
same source[.]” Detroit Ath., 903 F.3d at 1307 (citation omitted).
“Evidence of relatedness [of the services] may include . . . advertisements showing
that the relevant . . . services are advertised together or sold by the same
manufacturer or dealer; or copies of prior use-based registrations of the same mark
for both applicant’s . . . services and the . . . services listed in the [C]ited
[R]egistration.” In re OSF Healthcare Sys., No. 88706809, 2023 TTAB LEXIS 353, at
*9 (TTAB 2023). “It is sufficient for finding a likelihood of confusion if relatedness is
established for any item encompassed by the identification of goods within a
particular class in the application.” In re Samsung Display Co., No. 90502617, 2024
TTAB LEXIS 258, at *7 (TTAB 2024) (citation omitted); see also Tuxedo Monopoly,
Inc. v. Gen. Mills Fun Grp., 648 F.2d 1335, 1336 (CCPA 1981).
As for channels of trade or classes of consumers where, as here, there are no
limitations in Applicant’s or the Cited Registration’s identifications of services, we
must presume that the services “travel in all normal channels and to all prospective
purchasers for the relevant [services].” Coach Servs., 668 F.3d at 1370.

Serial No. 90828203
- 18 -
In our analysis, “[b]ecause each class in Applicant’s multi-class application is, in
effect, a separate application, we consider each class separately, and determine
whether the Examining Attorney has shown a likelihood of confusion with respect to
each.” OSF Healthcare, 2023 TTAB LEXIS 353, at *9-10 (citation omitted).34
1. Class 41
Applicant’s services in Class 41 are “providing classes, seminars, workshops,
programs, and training in the fields of pregnancy, childbirth, fertility, preconception,
conception, postpartum depression, miscarriage and loss, parenting, menopause, and
mental health.” The services in the Cited Registration are “medical services.”
The Examining Attorney submitted evidence of 21 use-based third-party
registrations which it asserts are “for use in connection with the same or similar
services as those of both [A]pplicant and [R]egistrant in this case.”35 Just as with the
third-party registrations Applicant submitted, we do not consider three of the
registrations because they have been cancelled. See Made in Nature, LLC v.
Pharmavite LLC, No. 91223352, 2022 TTAB LEXIS 251, at *31-32 (TTAB 2022)
(“disregard[ing] . . . cancelled trademark registrations”).36 Additionally, we do not
consider an additional four third-party registrations submitted by the Examining
Attorney because they do either do not cover the medical services from the Cited
34 Where, as here, an appeal involves a multi-class application, “examining attorneys and
applicants should facilitate the Board’s review by discussing the evidence of relatedness on a
class-by-class basis.” OSF Healthcare, 2023 TTAB LEXIS 353, at *10.
35 10 TTABVUE 14; 4 TTABVUE 14-57.
36 4 TTABVUE 34-35 (Reg. No. 5699143), 44-45 (Reg. No. 4684006), and 50-51 (Reg. No.
5808177).

Serial No. 90828203
- 19 -
Registration, or the medical services have been cancelled.37 The remaining 14 third-
party registrations do cover classes, seminars, or workshops that fall within one or
more of the same fields designated by Applicant in its identification of services for
Class 41 as well as covering services that fall within the medical services in the Cited
Registration.38
The Examining Attorney also submitted screenshots from 12 third-party websites
of hospitals or other medical providers “obtained via the Google® internet search
engine demonstrating that the same entity commonly provides the relevant services
and markets the services under the same mark.”39 Our review of the website
screenshots confirms that all 12 third-party entities offer both various childbirth,
parenting or other classes similar to those identified in Applicant’s Class 41 services40
as well as the Cited Registration’s medical services.41
37 Id. at 16-17 (Reg. No. 3951300), 18-19 (Reg. No. 6270220), 20-21 (Reg. No. 6437595), and
52-53 (Reg. No. 7475941).
38 Id. at 14-15 (Reg. No. 6042658), 22-23 (Reg. No. 7701940), 24-26 (Reg. No. 7151319), 27-29
(Reg. No. 7454447), 30-31 (Reg. No. 7672724), 32-33 (Reg. No. 5219235), 36-37 (Reg. No.
6817836), 38-39 (Reg. No. 7662786), 40-41 (Reg. No. 7648741), 42-43 (Reg. No. 5819047), 46-
47 (Reg. No. 7503661), 48-49 (Reg. No. 6958369), 54-55 (Reg. No. 7151008), 56-57 (Reg. No.
6077594).
39 10 TTABVUE 13-14; April 5, 2022 Office Action at 11-58; July 16, 2024 Final Office Action
at 19-145.
40 April 5, 2022 Office Action at 14-17 (Medstar Health), 22, 26 (Holy Cross Health), 29-35
(Massachusetts General Hospital), 50-54 (Riverside); July 16, 2024 Final Office Action at 24-
25 (VHC Health), 36-39 (Inova), 46-49 (Mary Washington Healthcare), 61-71 (Sutter Health),
77-79 (Women & Infants Hospital), 100-112, 121 (UPMC), 130-131, 134 (WakeMed), 144
(Michigan Medicine Von Voigtlander Women’s Hospital).
41 April 5, 2022 Office Action at 12 (Medstar Health), 23, 25 (Holy Cross Health), 36-41
(Massachusetts General Hospital), 46-48 (Inova), 56-57 (Riverside); July 16, 2024 Final Office
Action at 19 (VHC Health), 52-53 (Mary Washington Healthcare), 55-56 (Sutter Health), 82-
84 (Women & Infants Hospital), 96 (UPMC), 124 (WakeMed), 139-140 (Michigan Medicine
Von Voigtlander Women’s Hospital).

Serial No. 90828203
- 20 -
Applicant argues that Applicant’s and the Cited Registration’s services are
classified in different classes and that “[t]hese classifications are distinct for a
reason.”42 But “[c]lassification is solely for the convenience of Patent and Trademark
Office administration, 15 U.S.C. § 1112, and is wholly irrelevant to the issue of
registrability under [S]ection [2](d), which makes no reference to classification.”
Detroit Ath., 903 F.3d at 1307 (citation omitted); NFL v. Jasper Alliance Corp., No.
91077966, 1990 TTAB LEXIS 37, at *10 n.5 (TTAB 1990) (“The classification system
was established for the convenience of the Office rather than to indicate that goods .
. . in different classes indicates that they are not related”).
Applicant does not specifically address the Examining Attorney’s evidence but
instead argues that:
Applicant offers specific and highly specialized educational
and personal support services in the field of women’s
health. Its services are aimed at guiding and providing
information to women in a supporting and informative
way, short of any sort of medical analysis, diagnosis or
treatment. Applicant’s Services cover the social support
aspects of fertility, childbearing and rearing, and the
wellness issues that arise from the specific stages and
aspects of a women’s life. By contrast, Registrant offers
“medical services”, which include the highly skilled and
precise medical analysis, diagnosis and treatment that
Applicant’s Services exclude. Notably, unlike Applicant’s
Services, Registrant’s Services are targeted to diagnosing,
treating and healing medical issues.43
Yet, Applicant’s argument misses that the medical analysis, diagnosis, and
treatment that Applicant identifies as part of the Cited Registration’s medical
42 8 TTABVUE 4-5.
43 Id. at 5.

Serial No. 90828203
- 21 -
services, includes such analysis, diagnosis, and treatment of medical issues in the
“highly specialized” “field of women’s health” in which Applicant provides its support
services. And the Examining Attorney’s evidence of third-party registrations and
medical provider websites demonstrates that the same entity provides both the
“educational and personal support services” Applicant states that it provides as well
as the Cited Registration’s medical services “targeted to diagnosing, treating and
healing medical issues” under the same mark. For example, Medstar Health’s
“maternity care services” includes “emergency triage, surgical suites, and a team of
24-hour anesthesiologists, midwifery, OB/GYN practitioners, and neonatologists to
provide care for all full-term, ill, or premature newborns”44 as well as a “wide range
of classes to help you prepare for your baby’s arrival” including “childbirth and
parenting education classes.”45
We find the Examining Attorney’s evidence of 14 third-party registrations and 12
third-party uses supports the relatedness of Applicant’s and the Cited Registration’s
services.
With regards to trade channels, as discussed above, the Examining Attorney
provided evidence of the following 12 hospital or medical providers offering both
various childbirth, parenting or other classes similar to those identified in Applicant’s
Class 41 services as well as the Cited Registration’s medical services: Medstar
Health, Holy Cross Health, Massachusetts General Hospital, Inova, Riverside, VHC
44 April 5, 2022 Office Action at 12.
45 Id. at 14, 16.

Serial No. 90828203
- 22 -
Health, Mary Washington Healthcare, Sutter Health, Women & Infants Hospital,
UPMC, WakeMed, and Michigan Medicine Von Voigtlander Women’s Hospital.46 This
evidence demonstrates that the normal trade channels for Applicant’s services in
Class 41 and Registrant’s services overlap.47
In addition, the Examining Attorney’s evidence also establishes that the relevant
classes of consumers overlap. Specifically, the consumers of Applicant’s and
Registrant’s services include women seeking both social support in the areas of
fertility, pregnancy, childbirth, parenting, and related mental health issues, as well
as women seeking medical services in the areas of fertility, gynecology, maternal fetal
medicine, reproductive medicine, and obstetrics. Applicant argues that:
Registrant’s Services are distinct in that they are broadly
directed to ANY person seeking medical services. This is in
stark contrast from Applicant’s Services, which are
relevant specifically to women who are either trying to
become pregnant, have had children, and are otherwise
dealing with matters concerning fertility and women’s
health and wellness.48
Yet, Applicant ignores that “any person seeking medical services” offered by
Registrant encompasses women requiring medical treatment for issues relating to
46 See supra n. 40 and 41.
47 Applicant argues that, “Applicant’s and Registrant’s respective services do not travel in the
same channels of trade, as Applicant offers highly specialized subject matter education and
support in the field of women’s issues, and the Registrant offers broad medical services to the
general population.” 8 TTABVUE 6. We do not find Applicant’s argument persuasive.
Registrant’s “broad medical services to the general population” includes medical treatment
in “the field of women’s issues” directed to women who are part of the general population.
48 8 TTABVUE 5.

Serial No. 90828203
- 23 -
pregnancy, fertility, and women’s health, and therefore the relevant consumers
overlap.
Accordingly, the second and third DuPont factors favor a finding of likelihood of
confusion as to the services in Class 41.
2. Class 45
Applicant’s services in Class 45 are “organizing, managing, and facilitating
support groups in the fields of pregnancy, childbirth, fertility, preconception,
conception, postpartum depression, miscarriage and loss, parenting, menopause, and
mental health.” And as a reminder, the services in the Cited Registration are “medical
services.” The Examining Attorney relies on the same 21 third-party registrations,
and screenshots from 12 third-party medical provider websites to demonstrate the
similarities between Applicant’s Class 45 services and the Cited Registration’s
“medical services.”49
For the third-party registrations, just as for the Class 41 services, we do not
consider the seven registrations that were either cancelled or do not cover the Cited
Registration’s services. A review of the 14 remaining registrations shows that only
two third-party registrations cover both support group services similar to Applicant’s
Class 45 services and services that fall within the medical services in the Cited
Registration.50 We find that these two third-party registrations are insufficient to
support the similarity of the services in Class 45.
49 10 TTABVUE 13-14.
50 4 TTABVUE 32-33 (Reg. No. 5219235), 38-39 (Reg. No. 7662786).

Serial No. 90828203
- 24 -
Turning to the screenshots of the 12 third-party medical provider websites, a
review shows that 11 of these third-party uses offer both support group services in
various fields (e.g., pregnancy, childbirth, miscarriage, parenting, menopause)
similar to those identified in Applicant’s Class 45 services51 as well as the Cited
Registration’s medical services.52 We find that these 11 third-party uses are sufficient
to support the similarity of the services in Class 45. These third-party uses also
establish that the normal trade channels and classes of consumers for Applicant’s
Class 45 services overlap with Registrant’s services.
Applicant relies on the same arguments regarding the dissimilarity of Applicant’s
services, trade channels, and consumers for its Class 45 services as it does for its
Class 41 services. These arguments are unpersuasive for the same reasons discussed
above.
Accordingly, the second and third DuPont factors favor a finding of likelihood of
confusion as to the services in Class 45.
D. Consumers’ Sophistication and Purchasing Conditions
In analyzing consumers’ sophistication, we consider the “conditions under which
and buyers to whom sales are made, i.e., ‘impulse’ vs. careful, sophisticated
51 April 5, 2022 Office Action at 12, 17 (MedStar Health), 27 (Holy Cross Health), 42-45
(Inova), 55 (Riverside); July 16, 2024 Final Office Action at 30-31 (VHC Health), 49-50 (Mary
Washington Healthcare), 58 (Sutter Health), 72-76 (Women & Infants Hospital), 91-92, 96
(UPMC), 127, 137 (WakeMed), 142 (Michigan Medicine Von Voigtlander Women’s Hospital).
52 April 5, 2022 Office Action at 12 (Medstar Health), 23, 25 (Holy Cross Health), 46-48
(Inova), 56-57 (Riverside); July 16, 2024 Final Office Action at 19 (VHC Health), 52-53 (Mary
Washington Healthcare), 55-56 (Sutter Health), 82-84 (Women & Infants Hospital), 96
(UPMC), 124 (WakeMed), 139-140 (Michigan Medicine Von Voigtlander Women’s Hospital).

Serial No. 90828203
- 25 -
purchasing.” DuPont, 476 F.2d at 1361. We must base our decision on “the least
sophisticated potential purchasers.” Stone Lion, 746 F.3d at 1325.
Applicant argues that:
[D]ue to the highly technical and medically specific nature
of the services offered by Registrant, consumers seeking
Registrant’s medical services are likely to be highly
discerning in seeking, researching, and selecting medical
care. As such, given the level of care and attention
necessary to select a medical services provider, it is
unlikely consumers will be confused. Consumers are
unlikely to be confused by Applicant’s support services
offered to women.53
The Examining Attorney responds that “[t]he identity of the marks and the
relatedness of the services outweigh any presumed sophisticated purchasing
decision.”54
We agree with Applicant. Here, while consumers of Applicant’s and Registrant’s
services are from the general public, both Applicant’s and Registrant’s services are
offered in the healthcare field. “[I]t is common knowledge that even ordinary
consumers tend to exercise some sophistication when it comes to decisions relating to
healthcare.” Carefirst of Md., 2005 TTAB LEXIS 600, at *37.
Applicant’s and Registrant’s healthcare services “by their intrinsic nature, are not
impulse purchases.” In re Jimenez, No. 97551823, 2025 TTAB LEXIS 441, at *19
(TTAB 2025). Indeed, screenshots from Applicant’s website submitted by both the
Applicant and the Examining Attorney demonstrate that the process for obtaining
53 8 TTABVUE 5-6.
54 10 TTABVUE 16 (citation omitted).

Serial No. 90828203
- 26 -
care “may involve multiple steps and may be complex” including: referral by a
consumer’s OBGYN to Applicant,55 consultation to explore support options,56 creation
of a “personalized care plan,”57 matching consumers with their individual healthcare
providers,58 and also involves insurance coverage.59 See id. at *19-20 (evidence
supporting an “elevated level of care” included applicant’s touting “his ability to assist
his customers with insurance claims” and his website “invit[ing] consumers to
schedule a consultation”).
“Simply put, in purchasing healthcare services, even ordinary consumers are
likely to exercise greater care and will know with whom they are dealing.” Carefirst
of Md., 2005 TTAB LEXIS 600, at *38. Accordingly, this factor weighs against a
likelihood of confusion.
E. Conclusion
After reviewing the evidence of record, and the arguments relating thereto, we
conclude that the record here does not show a likelihood of confusion. Applicant’s and
Registrant’s marks are dissimilar, which weighs heavily against a likelihood of
confusion. See QuikTrip W., Inc. v. Weigel Stores, Inc., 984 F.3d 1031, 1037 (Fed. Cir.
2021) (“One DuPont factor may be dispositive in a likelihood of confusion analysis,
especially when that single factor is the dissimilarity of the marks.”) (citation
55 4 TTABVUE 8 (“92% of members are referred by their OBGYN to Seven Starling”).
56 Id. at 6, 9; December 13, 2024 Request for Reconsideration at 46.
57 4 TTABVUE 9.
58 Id.
59 Id. at 6 (“pricing & insurance”), 10-11 (FAQs include questions about insurance coverage).

Serial No. 90828203
- 27 -
omitted); Keystone Consol., 2024 TTAB LEXIS 290, at *86 (“dissimilarity of the marks
weighs heavily against likelihood of confusion”). Also supporting that confusion is not
likely is that Registrant’s mark has some conceptual weakness, and the greater care
exercised by consumers.
On the other side, the relatedness of the services, and the overlap of the channels
of trade and classes of consumers weigh in favor of a likelihood of confusion.
Considered together, we find that on this record the differences in the marks, that
the Cited Registration has some conceptual weakness, and the greater care exercised
by consumers in purchasing healthcare services outweigh the similarity of the
services and the overlap in trade channels and consumers. Accordingly, we conclude
confusion is unlikely.
Decision: The refusal to register under Section 2(d) is reversed.