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Telemedicine Consultation Form

Lupus

Please complete the following Clinical form if you wish to be treated for lupus.

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 information.

Clinical History Form - Lupus

If you wish to be considered for treatment of Lupus with Throne’s Stem Cell Educator Therapy, please submit the following information

Your Sex

Lupus Diagnosis

Check the boxes for any of these common lupus symptoms that you have had
Check any of the lupus treatments listed below if you have ever taken them:
Check any of the lupus treatments listed below if you are taking them now:
Do You Have Any Of These Other Autoimmune Disorders? Check All That Apply.
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 Lupus.

Required HIPPA Privacy Practices Notice (to see HIPAA Policy (see our HIPPA policy at https://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/npp_fullpage_hc_provider.pdf
Email Communication Authorization: I give permission for Throne Biotechnology And Its Doctors To Communicate With Me Regarding My Care By Telephone, Text Message, or Email.