• Regenerative Joint Care — Candidacy Screen

    Share your symptoms, history, and any red-flag details so we can route you to a consultation to discuss next steps.

  • Thinking about regenerative joint care?


    This quick screen helps us understand your situation before your consultation. It is not a diagnosis and does not determine whether a treatment is right for you. 

    After you complete the form our team will reach out to you to schedule a consutlation.

  • Format: (000) 000-0000.
  • Which office is more convenient for you?*
  • Which joint or area is bothering you most?*
  • How long have you had this pain or limitation?*
  • Pain rating (0 = no pain, 10 = worst pain imaginable)*
  • How is it affecting your daily life or activity?*
  • What have you already tried?*
  • Has a doctor ever recommended joint replacement or surgery for this?*
  • Our regenerative treatments are a private-pay service and aren't covered by insurance. Your consultation is where Dr. Fischer or Dr. Knight reviews your case and walks you through your options and the investment involved. Are you open to learning about private-pay treatment if you're a good candidate?*
  • These help us prepare for your visit. Please answer honestly — none of these automatically rule anything out, they just help us care for you safely.
  • Are you currently undergoing treatment for cancer (chemo, radiation, etc.)?*
  • Are you currently pregnant or breastfeeding?*
  • Do you have any active infection right now, or an infection or open wound near the affected joint?*
  • Do you have a bleeding or clotting disorder, or take blood thinners?*
  • Do you have an autoimmune condition or take immunosuppressant medication?*
  • Thank you. This does not determine whether a specific treatment is right for you — your consultation does. A member of our team will reach out to schedule your visit at the office you selected. If you have urgent symptoms such as fever, severe swelling, or a hot, red joint, please contact a physician promptly rather than waiting for your consultation.

  • Consent & Privacy Acknowledgment:This form collects health information so Bay Area Orthobiologics can contact you and prepare for your consultation. The information you provide is handled confidentially in accordance with HIPAA and the California Confidentiality of Medical Information Act (CMIA). Submitting this form does not create a doctor-patient relationship and is not a request for emergency care. By submitting, you consent to Bay Area Orthobiologics contacting you by phone, text, or email regarding your inquiry and scheduling. You may opt out of communications at any time. For details on how we collect, use, and protect your information, see our Privacy Policy and Notice of Privacy Practices.

     

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