Welcome to the StemGenex Medical Group Medical History Form
This medical history survey is used to determine a patient’s candidacy for safe and effective stem cell therapy through StemGenex Medical Group.
Please fill out as many questions as possible so we can determine if our stem cell clinic is right for you.
StemGenex® takes great pride in our response time to your inquiry and providing you with the highest level of service possible. You should expect to hear back shortly from your patient advocate to confirm that we have received your application form. Please list the single best phone number to reach you, Monday-Friday 8am-6pm Pacific Standard Time (PST).