Harbor Comprehensive Health

Prospective Client Questionnaire

Basic Information

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Select your age range
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1. Are the following body areas painful to you?

Joint Arthritis
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Wrist or Hand
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Elbow
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Knee
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Ankle or Foot
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Back or Hip
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Shoulder
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How long has this pain been going on?
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2. Has a medical professional told you that you need one of the following:

Shoulder Replacement
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Hip Replacement
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Knee Replacement
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3. Are you currently working?

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Do you get most of your pain before, during or after work?
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4. Have you received a stem cell treatment before?

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5. What interests you most about Stem Cell Regenerative Treatments?

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