Start Your PRP Journey Today!

Patient Information:

First Name *

Last Name *

Date of birth

Phone *

Email *

Preferred Contact Method: (Select all that apply) *

Phone

Text/SMS

What Brings You In?

How long have you had this issue? (Select all that apply) *

Less than 3 months

3 - 6 months

Over 6 months

Years

What Are Your Goals?

Concerns & Expectations:

What questions or concerns do you have about PRP?

Have you heard anything about PRP that you'd like to clarify?

Scheduling Preferences:

Are you interested in a same-day consultation and/or treatment? (if eligible)

Yes

Unsure

Final Notes:

All procedures are performed personally by Dr. Jose R. Ortega using ultrasound-guided precision.

PRP is derived from your own blood and designed to help your body heal naturally - without steroids or surgery.

The consultation will include a medical evaluation, discussion of my goals, and a personalized recommendation.

Treatment options, including PRP, will be explained clearly — along with expected outcomes, possible risks, and alternative options.

Pricing and coverage information will be discussed in detail during my visit so I can make an informed decision.

By checking this box, I consent to receive messages related to services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

By submitting this form, I acknowledge that I am requesting a consultation with Dr. Jose R. Ortega to learn more about Platelet-Rich Plasma (PRP) therapy and whether it may be an appropriate option for my joint condition.