Stem Cell Therapy Consultation Request Form

Streamline Your Stem Cell Therapy Consultations with Paperform

Are you a regenerative medicine clinic, stem cell therapy center, or healthcare provider looking to efficiently qualify and consult with potential stem cell therapy patients? This Stem Cell Therapy Consultation Request Form template helps you gather comprehensive patient information, assess treatment eligibility, and set realistic expectations—all before the first appointment.

Why This Form Template Works for Regenerative Medicine Practices

Stem cell therapy consultations require collecting detailed medical history, understanding patient expectations, and determining whether someone is a good candidate for treatment. This form template streamlines that entire intake process by asking the right questions upfront, helping you:

• Pre-qualify patients based on their condition, medical history, and treatment goals
• Understand treatment preferences including clinical trials vs. approved therapies
• Assess international treatment interest for patients exploring options abroad
• Set realistic expectations about outcomes and timelines
• Save consultation time by having all necessary information before the appointment

Whether you're offering stem cell treatments for orthopedic conditions, neurological disorders, autoimmune diseases, or aesthetic procedures, this template adapts to your specific practice needs.

Perfect for Healthcare Providers in Regenerative Medicine

This form template is ideal for:

• Stem cell therapy clinics offering treatments for various conditions
• Orthopedic practices specializing in joint and tissue regeneration
• Pain management centers exploring regenerative solutions
• Anti-aging and wellness clinics providing aesthetic stem cell treatments
• International medical tourism facilitators connecting patients with global treatment options
• Clinical research coordinators recruiting for stem cell therapy trials

Key Features That Make Patient Intake Seamless

Comprehensive Medical Assessment: Collect detailed information about the patient's condition, previous treatments, and medical history to determine eligibility and appropriate treatment pathways.

Treatment Preference Mapping: Understand whether patients are interested in FDA-approved therapies, clinical trials, or international treatment options, helping you guide them to the right solution.

Expectation Management: Built-in questions help patients articulate their treatment goals and expected outcomes, allowing you to address realistic expectations during consultation.

Conditional Logic: The form adapts based on patient responses, showing relevant follow-up questions only when needed—creating a streamlined experience that doesn't overwhelm.

Professional, Trustworthy Design: With clean, medical-grade aesthetics and clear language, this form builds patient confidence from the first interaction.

Automate Your Consultation Workflow with Stepper

Once you've collected consultation requests, you can use Stepper to automate everything that happens next:

• Automatically schedule consultation appointments based on urgency and condition type
• Route clinical trial candidates to your research coordinator
• Send different educational resources based on the patient's specific condition
• Trigger CRM updates and add patients to condition-specific nurture sequences
• Alert specialists when high-priority or complex cases are submitted
• Create patient files in your practice management system automatically

This means your team spends less time on administrative tasks and more time providing exceptional patient care.

Collect Payments and Deposits Seamlessly

If you charge consultation fees or require deposits for treatment planning, Paperform's built-in payment processing makes it simple. Connect Stripe, PayPal, or Square to collect payment directly in the form—no separate invoicing needed.

Why Healthcare Providers Choose Paperform

With over 500,000 teams worldwide trusting Paperform, healthcare providers love how easy it is to create professional, conversion-optimized forms without any coding. You get:

• SOC 2 Type II compliance and GDPR readiness for patient data security (note: Paperform is not HIPAA compliant)
• Conditional logic that adapts the form based on patient responses
• Custom branding to match your clinic's professional image
• Automatic email confirmations with next steps and preparation instructions
• Integration with your existing tools including CRMs, Google Calendar, Slack, and more

Get Started in Minutes

This template is ready to use out of the box, but you can easily customize every question, add your logo, adjust the colors to match your brand, and modify the workflow to fit your practice. Whether you're a solo practitioner or managing multiple locations through an agency, Paperform scales with your needs.

Start converting more consultation inquiries into qualified patients with a form that works as hard as you do. The combination of thoughtful question design, professional aesthetics, and powerful automation makes this template the ideal starting point for any regenerative medicine practice looking to streamline patient intake and grow their stem cell therapy program.