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Regenerative Medicine Questionnaire

Please complete the questionnaire below and submit. One of our Patient Coordinators will call you within one working day to discuss if you are a good candidate for regenerative medicine.

Will this be your first visit?

Where is the pain located?

What aggravates your symptoms?

What alleviates your symptoms?

When your pain is at the very best, what would you rate it out of 1-10?

When your pain is at the very worst, what would you rate it out of 1-10?

What treatment(s) have you had to date?