1. What condition are you primarily seeking treatment for? *

Advanced joint degeneration / arthritis

Sports injury not improving

Spine or disc condition

Chronic pain lasting 6+ months

Other serious orthopedic condition

2. How long has this condition significantly impacted your daily life? *

Less than 6 months

6–12 months

1–5 years

5+ years

3. Have you already tried conservative or surgical treatments? *

Yes - multiple treatments without lasting relief

Yes - surgery recommended but I want alternatives

No - just beginning to explore options

4. Regenerative treatments at The Goswami Clinic are elective and NOT covered by insurance. Investment typically ranges from $10,000–$35,000+ depending on your personalized protocol. Are you financially prepared to invest in premium non-surgical care if approved by our doctors? *

Yes - I am prepared to invest if I’m a candidate

No - I’m looking for insurance-covered options

5. Our primary clinic is located in Newport Beach, California. If you are Out-of-State, Are you willing and able to travel for treatment if recommended? *

Yes - travel is not an issue

Possibly - depends on treatment plan

No - I am looking for something local

6. Our Patient Care Coordinator reserves a private 15–20 minute consultation exclusively for serious applicants. If you’re approved to book, are you willing to commit to attending at your scheduled time and giving us at least 24 hours’ notice if you need to reschedule? *

Yes - I will absolutely attend

I’m unsure about my schedule

Full Name *

Email *

Phone *

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