We look forward to hearing from you
Thank you for choosing to get in touch with us. If you are interested in having your personal medical history evaluated, please fill in the Patient Questionnaire on the right. Once we receive your request, we will review your answers in order to determine eligibility (“Eligibility” or “Eligible”) for referral to a licensed medical professional for purposes of receipt of certain treatments. Looking forward to hearing from you.
Please note that all fields on the form are required and that we process your personal data only as necessary for the provision of our services.
General Inquiry Form
If you are a doctor or researcher who is contacting us about a general matter, please click here to fill out our general inquiry form.
If you are interested in an initial review of your medical documentation, please fill out the form above.