Candidate Form

The following is the new patient candidate form, and follows the phone conversations, giving you questions to ask in the order the conversation should go. Orange text is scripted.

Section A




Section B


How did you hear about us?


Section C


To begin with, do you have any questions about stem cells or the type that we use? After this phone call, you will receive an email that will give you more information about it.

Review process of how we acquire the umbilicals, considered very safe for local injections. (Will be emailed to the patient.)

Review why we use umbilicals as opposed to other types of stem cells. We used to use adipose derived; bone marrow is an actual procedure; point: umbilicals are young-potent cells.

Has imaging been performed?

  Yes      No

Past Surgeries or Procedures

Pertinent History

Pre-Procedure Recommendations


Section D



Section E


Review with patient:

  • benefits of umbilical injections vs surgery:
    • no downtime
    • 1-2 day appointment
  • Review again, umbilicals are young-potent cells.
  • Review costs of umbilical vials, 30 million cells = $5k per vial
  • Tailor the details of the costs based on what the candidate is looking to treat, more than 1 joint, $5-10k, etc.

Section F


Review with patient:

  • typical scenario of first appointment.
  • Injection Consultation, Exam, Time and Rate (cost)
  • Injection(s) to follow, how long for the entire appointment
  • Options for 1 day or 2 days (2nd day @ 30 days later)
  • We do require prepayment

When would you like to schedule?