Regenerative and Longevity Medicine Section Sign Up form

ASIPP Regenerative Medicine and Longevity Section Sign Up Form

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PLEASE ANSWER ALL OF THE FOLLOWING QUESTIONS:

Medical Degree:

Other

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Primary Specialty Certification:

Other

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Are you certified by ABIPP's Competency in Regenerative Medicine and Longevity Medicine?

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Pain Medicine Subspecialty Certification

Other

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Fellowship Training

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Years in IPM practice:

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Years in Regenerative Medicine Practice:

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Please indicate your present practice and interest in regenerative medicine procedures related to Intraarticular Procedures and Soft Tissue Injections.

Rows	PRP	Bone Marrow Aspirate	Adipose Derived Biologics
Soft Tissue Injections
Shoulder Injections
Elbow Injections
Wrist Injections
Hip Injections
Knee Injections
Ankle Injections

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Please indicate your present practice and interest in regenerative medicine procedures related to Spine Procedures.

Rows	PRP	Bone Marrow Aspirate	Adipose Derived Biologics
Lumbar Intradiscal Injections
Thoracic Intradiscal Injections
Cervical Intradiscal Injections
Lumbar Facet Joint Injections
Thoracic Facet Joint Injections
Cervical Facet Joint Injections
Lumbar Epidural Injections
Thoracic Epidural Injections
Cervical Epidural Injections
Sacroiliac Joint Injections

Describe other types of interventions you've practiced if applicable.

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