Personal Information


Your Health History



Present State Of Health: Please select the option that best describes your present state of health.


Please describe broadly your current diagnosis:



Family Current State Of Health (Age & Health State/Condition)



ADDITIONAL MEDICAL INFORMATION



Have you ever been exposed to any of the following?


Habits



General:


Gynecological History:
Do you have a history of ovarian cysts, uterine fibroids, or endometriosis?
Please list the number of each of the following:


Breasts:


Food Issues/Sensitivities:


Gastrointestinal:


General Digestion Problems: Past & Present:

Renovation Advanced Therapy Center is always making strides in the advancement of stem cell therapy, dedicated to providing patients safe and effective stem cell treatments. Our patients receive the highest quality of patient care, according to current practices and procedures. We are actively participating in the medical industry to be up-to-date in healthcare options.