Bayou Phoenix Regenerative Medicine

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What is the primary condition or health goal you are hoping to address?

Joint pain, arthritis, or decreased mobility

Back, neck, or musculoskeletal pain

Chronic inflammation or autoimmune-related concerns

Recovery from an injury

Performance, healthy aging, or longevity

Overall wellness and health optimization

Other

Are you willing to complete a physician consultation and medical review to determine whether regenerative medicine is medically appropriate for you?

Yes

No

Bayou Phoenix regenerative medicine services are cash-pay and are not billed to insurance. Do you understand that you would be responsible for the cost of your treatment?

Yes, I understand

No

Regenerative treatment plans commonly range from approximately $4,000–$9,500, depending on the treatment recommended. If you are determined to be an appropriate candidate, would you be comfortable considering treatment within this range?

Yes

No

Do you understand that the regenerative therapy being considered is not FDA-approved to treat or cure the condition for which you are seeking care, results cannot be guaranteed, and treatment would only be recommended after an individualized physician evaluation?

Yes, I understand

No

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Completion of this questionnaire does not determine medical candidacy.

Final recommendations are made following physician evaluation and review of the individual's medical history.

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