Patient Forms

Welcome to New Age Therapeutics! If you are a new patient interested in our Stem Cell Therapy treatments, please complete the Stem Cell Screening form below. This form will help us determine if you qualify for our stem cell treatments. All new patients approved for Stem Cell Therapy or Exosome Therapy must also submit the Intake Form. We will ask you to include your medical history and important documents. All of our forms are HIPPA compliant, so your information is safe and protected.

If you want to stay in touch with us, you may fill out the Contact Form. We would love to answer any questions you have.

You can access each form by clicking on the yellow buttons below. If you have questions, please don’t hesitate to reach out. We are happy to help!

Learn More About New Age Therapeutics

Questionnaire for Stem Cell Treatments

Do you want to learn more about stem cell therapy? Complete the screening form below to see if you qualify for stem cell treatments.

Stem Cell Questionnaire Form


Intake Form

New patients: Please fill out this intake form. This is required for all patients considering treatment at New Age Therapeutics.

Intake Form


Contact Information

Have a question or want to stay in touch with us? Please fill out this form so we have your information on file.

Contact Information Form



Please reach out if you have any questions. We look forward to helping you heal!

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