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Telemedicine Consultation Form

Type 1 Diabetes - Adult

Please complete the following Clinical form if you wish to be treated for adult Type 1 Diabetes.

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 Form - Type 1 Diabetes - Adults

Your Sex

Have You Been Diagnosed With Type 1 Diabetes?
What Were Your Symptoms When First Diagnosed?
Is There A Family History Of Type 1 Diabetes?
Do You Have Any Of These Other Autoimmune Disorders? Check All That Apply.

If You Have Recent Blood Test Results, Please Enter Them Below

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