This information allows us to evaluate your case and determine how best to improve your medical condition. You can attach additional information/documents. The stem cell specialist will discuss options and treatment protocols with you to develop the best medical direction to take your treatment.
By filling out the questionnaire, the respondent certifies that he or she is at least 18 years of age (those younger than 18 must have a parent or guardian fill out the form). Patient or guardian permits us to use the information for the analysis and evaluation of their condition for treatment at our affiliated treatment center. All Patient Questionnaire information will be treated confidentially and will only be viewed by our organization and affiliated treatment center.