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Historial Médico

Progress
  • Patient General Information
  • Patient Geographic Information
  • Emergency Contact Information
  • Diagnosis Information
  • Medical Questionnaire
  • Symptoms
  • Last Medical Checkup
  • Patient Application Statement and Agreement
TEl siguiente formulario debe cumplimentarlo el paciente, o alguien en su nombre, incluyendo respuestas detalladas a todas las preguntas que se apliquen al historial médico del solicitante y al tratamiento al que se le esté considerando. Esta información ayudará al equipo médico a determinar si el paciente es un candidato a terapia de células madre. Por favor, espere de 3 a 5 días laborables una vez se hayan entregado todos los expedientes médicos requeridos para que la revisión médica se complete. Brevemente después, su Coordinador de Atención Médica entrará en contacto con usted para ayudarle a completar el proceso.
Por favor, complete el formulario de la forma más precisa posible. ¡Muchas gracias!

El asterisco (*) indica una información obligatoria.


Progreso
  • Información General del Paciente
  • Información Geográfica del Paciente
  • Información de Contacto de Emergencia
  • Información de Diagnóstico
  • Cuestionario Médico
  • Síntomas
  • Último Chequeo Médico
  • Acuerdo y Declaración de Solicitud del Paciente

4.9 
117 Reviews

Phones

727-800-4992
727-456-8968

Fax

727-362-4630

Working hours

8AM – 5PM EST
Monday to Friday

Location

Stemedix, Inc.
970 Lake Carillon Drive
Suite 300
Saint Petersburg, FL
33716, USA

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We'll send your FREE information packet that outlines our entire personalized, stress-free stem cell treatment process!

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Request Information Packet

We'll send your FREE information packet that outlines our entire personalized, stress-free stem cell treatment process!

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Request Information Packet

We'll send your FREE information packet that outlines our entire personalized, stress-free stem cell treatment process!

Thanks for your interest!

Request Information Packet

We'll send your FREE information packet that outlines our entire personalized, stress-free stem cell treatment process!

Thanks for your interest!