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Telemedicine Consultation Form

Post-COVID Syndrome

Please complete the following Clinical form if you wish to be treated for Post-COVID Syndrome

Throne Clinical History Form For Post-COVID Syndrome
Smelling disturbances
Tinnitus
Muscle pain
Hoarseness
Coughing
Chest pain
Stomach pain
Confusion
Hair loss
Chills
Insomnia

This is a form to submit information for the treatment of Post-COVID Syndrome (also known as Long COVID Syndrome) patients for possible treatment with Throne Biotechnologies’ Stem Cell Educator Therapy. Post-COVID Syndrome applies to those who had a COVID infection or a COVID vaccine and who were never fully recovered from after three months. The typical symptoms are (1) feeling fatigued most of the time, especially after physical activity and (2) "brain fog," a feeling of inability to think clearly. In addition to these symptoms, there may be other chronic symptoms involving other parts of the body. The syndrome is probably caused by the persistence of the inflammatory COVID spike protein in various organs of the body, whether the spike protein came from a COVID infection or a COVID vaccine. The persistent spike protein then often causes autoimmune inflammation in various organs, including the heart, lungs, brain, and the blood vessels of those organs. Stem Cell Educator Therapy often decreases or eliminates this autoimmune inflammation permanently unless there is further exposure to spike protein.

Impaired sense of taste
Joint pain
Sore throat
Wheezing
Diarrhea
Vertigo (dizziness)
Rash
Fever
Unrestful sleep
Running nose
Vomiting
Headache
Itching
General illness, flu-like symptoms
Nausea
Motor deficits (weakness)

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

Sensory deficits
Numbness
Tremor
Your Name
Your Name
First Name
Last Name
Inability to concentrate
Your Address
Your Address
City
State/Province
Zip/Postal
Country
Your Sex

COVID-19 Infection History

How many times do you think that you have had a COVID-19 infection, regardless of any test results?
How many COVID-like illnesses have you had during which you tested positive for COVID-19 infection?
If you had a COVID infection, how fully have you recovered from that most recent COVID infection? Enter "None" if no COVID infection.
If you had a COVID infection, when were you first treated for your most recent COVID-19 infection? Enter "None" if no COVID infection.
If you had a COVID infection, were you hospitalized for your COVID-19 infection?
If you had a COVID infection, were you hospitalized in intensive care for your COVID-19 infection?
If you had a COVID infection, did you require a mechanical ventilator to breathe when you hospitalized in intensive care for your COVID-19 infection?
If you had a COVID infection, did you receive any prescription medications for the treatment of your COVID-19 infection at the time of it? Check all that apply.
If you had a COVID infection, did you receive any non-prescription medications for the treatment of your COVID-19 infection at the time of it? Check all that apply.
If you had a COVID infection, how long after you started treatment was it until you began to feel better?

COVID Vaccination History

How many COVID vaccinations have you had?
Which initial series did you have?
How long after your COVID vaccination did you first develop signs of an adverse reaction, such as fatigue at rest, excessive fatigue after exertion, "brain fog"?
How serious was your adverse vaccination reaction?
When did you first seek medical attention for your COVID vaccine adverse reaction?

Post-COVID Severity Score

Sensory deficits
Fatigue that interferes with daily life Symptoms that get worse after physical or mental effort.
Joint or muscle pain
Ear-Nose-Throat (ENT) ailments
Coughing, wheezing
Chest pain
Gastrointestinal ailments
Neurological ailments
Skin issues
Signs of infection
Sleep disturbance
General Symptoms (check all that apply)
Psychological symptoms (check all that apply)
Decreased mobility due to pain or arthritis of hands, back, hips, or knees
Heart symptoms (check all that apply)
Respiratory symptoms
Blood clotting disorders
Digestive symptoms (click all that apply)
Reproductive symptoms (check all that apply)
New or recurrent cancer

General Health

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

Social History

Do you have a spouse or significant other relationship at this time?
Are You Employed At This Time?
Do You Have Or Need A Caretaker And, If So, Who Supplies That Care?
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