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Telemedicine Consultation Form

Chronic Fatigue Syndrome

Please complete the following Clinical form if you wish to be treated for Chronic Fatigue Syndrome.

Please review the Further Details Of Throne’s Stem Cell Treatment For Autoimmunity page at this link prior to submitting your request for Telephone Consultation since it will answer many of your general questions and allow us to focus on your specific questions during that consultation.

Clinical History Form - Chronic Fatigue Syndrome/Myalgic Encephalitis

If you wish to be considered for treatment of Chronic Fatigue Syndrome/Myalgic Encephalitis (CFS/ME), please submit the following information

Your Gender

General Health

Do You Have Any Of These Other Autoimmune Disorders? Check All That Apply:

Chronic Fatigue Syndrome History

Have you had A substantial reduction or impairment in ability to engage in pre-illness levels of activity (occupational, educational, social, or personal life)that lasted for more than 6 months
Have you had a substantial reduction or impairment in ability to engage in pre-illness levels of activity (occupational, educational, social, or personal life)that has been accompanied by fatigue that is (check all that apply):
Have you had Post-Exertional Malaise (PEM)*—worsening of symptoms after physical, mental, or emotional exertion that would not have caused a problem before the illness
I have unrefreshing sleep, where:
I have had cognitive impairment—problems with thinking, memory, executive function, and information processing, attention deficit, or impaired psychomotor functions
I have orthostatic intolerance— a worsening of my symptoms upon assuming and maintaining upright posture
I also have the following symptoms:

Social History

Are You Employed At This Time?
Do You Have Or Need A Caretaker And, If So, Who Supplies That Care?

DISCLAIMER: Throne Biotechnologies Stem Cell Educator Therapy is experimental and is not approved by the U.S. Food and Drug Administration for the treatment of Post-COVID Syndrome.

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