Case Evaluation Form

Patient Evaluation Form

Thank you for your interest in ProgenCell. Please fill out and submit the Confidential Candidate Application below.

To evaluate your case we will need the following information. This will help us determine if ProgenCell could consider you eligible for this protocol and perhaps help improve your medical condition.

Your case will be evaluated and answered in the next 72 hr.

Your information is considered CONFIDENTIAL thus it is handled with total discretion. Your data will not be shared with any institution and it is not used to send spam email.

Important: After being approved to participate in this research protocol, and before your arrival at ProgenCell®, we will require the following blood tests:

  • Complete Blood biometrics (with platelets)
  • Prothrombin time (PT)
  • Partial thromboplastin time (PTT)

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