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Treatment Information Request Form

Thank you for your interest in obtaining stem cell treatment. Please fill out and submit the information below. If you wish, an RSCI representative will get back to you promptly with all the information you will need to help you along your stem cell treatment journey and pair you with the top stem cell treatment center for your needs.

Our patient support program is free of charge, and all RSCI affiliated doctors and centers meet our very high treatment standards.

Treatment Information Request

RSCI respects your privacy and does not sell or distribute your information to third parties.

Patient Information
First Name: Last Name:

Country:
City: State/Province:

Year of Birth:

Primary Disease:
*Note: If you have a neurological condition that is not listed select Neurological-other or if you do not find your disease in the list, select Disease Not Listed, and add the disease to the message area.
Year Diagnosed:

Secondary diseases to treat – if any list them in this box:
Contact Information
If Different Than Patient’s Name Above, Your Name (otherwise leave blank and skip to Primary Phone question below):
First Name: Last Name:
Relation to Patient:

Primary Phone: Alt. Phone:
Best Time to Call:
Email:
Confirm Email:
Message:
Please review and check that you have read the following:






Important: Please click the "Submit Request" button one time. Double-clicking will submit a duplicate request. If you are the contact person for more than 1 patient, please use a seperate email for address for each patient. (We use email address as a key in our system)

Get Treatment Now

RSCI will give you:
  • All the information you need
  • Walk you through the process so you can avoid the many internet traps and misinformation
  • Guide you to one of the best stem cell research doctors in the world.
Best of all, there is NO charge for this service.

Click here to fill out a treatment information request form.

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The Truth About Stem Cells on BBS Radio

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Who is Don Margolis?

Since 2003, Don Margolis, a graduate of Drexel University, has dedicated himself to helping patients cut through political and religious debates and concentrate on the science of stem cell medicine and stem cell treatments.

Follow Don's blog at www.donmargolis.com.

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