Regenerative Medicine Patient Survey

This form is to be use to help patients understand if they may be a candidate for either regenerative medicine or joint replacement. This is not an exact science. This assessment is NOT a medical diagnosis. Consult your doctor before beginning any medical procedures.

After completing the survey, you will have a points total:

0-6 points: Yes, you are a candidate
7-8 points: Maybe, pending further face to face evaluation
9 points - No, pending that you cannot have a joint replacement

Name *
Phone *
Which joint is bothering you? *
Please include year MRI was taken
This is not stiffness, but actual catching causing you to lose balance
For knees only
Add up your points before hitting submit