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Thank You

We will now begin the process of determining your candidacy for stem cell therapy. Safety and efficacy are always taken into consideration when determining whether stem cell therapy through StemGenex Medical Group is a possibility for you.

Please expect a 24-48 hour turn-around time for our clinical team to review your history and determine if stem cell therapy is an option for you. A StemGenex Medical Group Patient Advocate will be in contact with you shortly to confirm that we have received your form and to answer any questions that you may have.

If you are submitting this form during non-business hours, we will attempt to contact you the next business day.  If you do have any questions, please call us at (800) 609-7795 or e-mail us at contact@stemgenex.com.

We look forward to speaking with you and becoming a part of your journey toward better health.

Need Assistance?

If you need assistance with your medical history form, please fill out the form below and a Patient Advocate will contact you shortly.

Contact us for more information about Stem Cell Treatment

To learn more about stem cell treatment simply fill out the form below and a Patient Advocate will contact you shortly.