Candidate Application Form

Thank you for your interest in the Stem Cell Project’s Pain Management Program. This application is intended for individuals seeking to participate in therapeutic treatments for chronic pain using regenerative medicine. The treatment options offered through the program include stem cell-based therapies such as:

• Allograft (Donor) Stem Cells
• Autologous (Self-Derived) Stem Cells (Bone Marrow Aspirate Concentrate or Adipose-Derived)
• Exosomes
• Platelet-Rich Plasma (PRP)

All procedures are administered and overseen by licensed physicians. Any personal or medical information submitted through this application will remain confidential and shared only with the Stem Cell Project and the evaluating physician. If your application is approved, you will be notified with instructions for the next steps in the process. Please note strict eligibility criteria are in place to ensure the safety and effectiveness of these treatments for each participant.

Eligibility Checklist

Please review the following criteria carefully. If you meet all of the requirements below, please proceed with the application:

• You have a confirmed diagnosis of chronic pain from a licensed physician.
• You are able to work with your primary care physician to discontinue NSAIDs and H2 blockers five (5) days prior to the procedure and manage anticoagulants like Lovenox or Coumadin as needed.
• You are financially unable to afford stem cell treatments and/or no insurance coverage for these procedures.
• Your gross annual household income falls within the following limits:

Note: We reserve the right to request your most recent IRS tax return to verify income eligibility.

Important Note:
Treatment locations are available across the United States. While we strive to match patients with providers near their place of residence, we cannot guarantee treatment will be available in a specific geographic location.

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