1. What type of pain or condition are you experiencing? *

A) Joint pain from arthritis or degeneration

B) A sports injury or soft tissue damage

C) Chronic pain that hasn’t improved with other treatments

D) Neuropathy: numbness, balance issues, burning/tingling/cold/hot sensations

2. Have you tried conventional treatments like pain medications, cortisone injections, or physical therapy without lasting relief? *

A) Yes, but my pain keeps coming back

B) Yes, and I only get temporary relief

C) No, but I want a natural alternative

D) No, my pain is well managed

3. Do you have a history of blood disorders or any type of cancer? *

A) No, I have no history of blood disorders or cancer

B) I have a history of blood disorders but would like to learn more

C) I have a history of cancer but am in remission

D) I am currently undergoing treatment for cancer or a blood disorder

(Some regenerative treatments may not be suitable for individuals with certain conditions.)

4. How long have you been dealing with this condition? *

A) Less than 6 months

B) 6 months to a year

C) Over a year

D) It just started

5. Are you looking for a non-surgical, natural treatment option? *

A) Yes, I want to avoid surgery if possible

B) Maybe, I’m open to exploring my options

C) No, I prefer traditional medical treatments

6. Are you willing to commit to post-treatment care, such as physical therapy and lifestyle changes, to maximize results? *

A) Yes, I want the best possible outcome

B) Maybe, if it’s not too demanding

C) No, I prefer a quick fix

Please complete the following to get your results.

Full Name *

Phone *

Email *

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