25+ Years of Experience Medellin's Family Legacy in Regenerative Cell Therapy
Stem Cell Treatment Application - Medellín
StemCell Institute

Stem Cell Treatment Application

Stem Cell Institute Medellín provides stem cell therapy for patients with autism, autoimmune diseases, cerebral palsy, heart failure, multiple sclerosis, osteoarthritis, rheumatoid arthritis, and spinal cord injuries.

Please complete the Stem Cell Treatment Application form with accurate and detailed medical information.

Our medical team will carefully review your clinical history to create a personalized treatment plan, including the recommended number of stem cells, exosomes, and any additional therapies. You will also receive a cost estimate and the medical requirements needed to move forward.

This evaluation is the first step to booking your consultation and starting your journey toward regenerative healing.

1
Personal Info
2
Patient Details
3
Medical History
4
Review

Please fill out the following application and submit it online or download the document to fill out and fax it. This treatment is not covered by most health insurance plans and requires travel outside the United States or Canada.

We do not treat:

  • ALS
  • Duchenne's Muscular Dystrophy

Personal Information

Patient Details

Guardian Information

Note: Complete this section if the patient is a minor or requires a guardian.

Physical Limitations

Contact Information

Contact Preferences

Note: One of our physicians may need to contact you (or the applicant's legal representative). Please provide the best phone number to reach you, Monday through Friday, 10:00 AM to 7:00 PM Central Time.

Emergency Contact

Medical History

Patient History: Cancer
Patient History: Diabetes
Patient History: Neurological System
Patient History: Cardiovascular System



Treatment Expectations

Additional Information

Consent and Authorization

Note: Processing your request may take more than a minute. Wait for a new page to appear confirming receipt of your application. After pressing the submit button, please do not reload the page or press the back button.

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