Full Name *

Email *

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

Possibly - I would need financing options

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 physicians reserve time exclusively for serious applicants. This is a 15–20 minute private consultation. If approved, do you commit to showing up at your scheduled time?

Yes - I will absolutely attend

I’m unsure about my schedule