Apply for Treatment

If you are interested in stem cell therapy, the first step to attaining this is to assess the appropriateness of this therapy for you. Please note, stem cell therapy is not appropriate for everyone.

Completing the Candidate Application Form allows our doctor to review your medical history to decide if stem cell therapy may be of benefit to you.

Please fill in the “Online Candidate Application Form” on this page which will then be automatically sent to us.

Our doctor will review your application and within 3 to 5 working days we will contact you to advise  if you have been approved or declined. If you are approved, we will also advise further steps which will include a consultation with one of our doctors.

You may also phone our head office to request that a “Candidate Application Form” be mailed to you with a stamped, addressed envelope to return to us.

Phone: 09 553 3012

You may also download a pdf version of our form by clicking the DOWNLOAD FORM button above.

If you are downloading a copy of our interactive pdf form, please print, complete and send to:

NZ Stem Cell Treatment Centre
67 Maunu Rd,
Whangarei

Or open the form with Acrobat Reader, complete, save and email to info@stemcell.co.nz. If you do not have Acrobat Reader installed, you can download a copy here.

Please note: If you do not hear back from the office within 72 hours, please contact our clinic by phone: 09 553 3012.

 

Online Candidate Application Form

* indicates a required field













Medical and Social Background






















Have you had any of the following? If YES, please explain below

Eyes

Pulmonary (Lung)

Gastrointestinal

Endocrine

Ears, Nose, Mouth and Throat

Cardiac (Heart)

Muscular / Skeletal

Neurologic

Allergies

Urinary Tract

Psychiatric

Reproductive System


Financial Policy

The fee quoted to you includes administration, the doctor’s time, nursing care, pre and post-operative clinic visits. All quotes are valid for 3 months.

To establish your health condition prior to deployment of SVF, you may be requested to have specific lab work, ECG, spirometry or radiology. This may be covered by private medical insurance.

When SVF is scheduled, a non-refundable $1,000 deposit is required to secure your theatre booking. The remaining balance of the fee is due two weeks prior to your deployment procedure.

In the event of cancellation of the procedure within seven days of the scheduled deployment date, 50% of the fees are non-refundable.