Patient's ORDER FORM

CLIENT'S ORDER FORM

		* Entry required
	Patient's ID code	*
	Email address:	*

	Physician's Name
	Street:
	City:
	Zip code:
	Country:

I would like to order the following stem cell transplants (Please use names from the list)
1.	8.
2.	9.
3.	10.
4.	11.
5.	12.
6.	13.
7.	14.

NOTE: Besides the listed kinds of stem cell transplants we can prepare, if necessary, also those of all other organs, tissues or cells.

Your REMARKS:


Date of order (dd.mm.yyyy)	*
Please write in the date of your stem-cell transplantation (dd.mm.yyyy)	*

The price will be quoted to you on your Ordering Client Information form, promptly after receiving your order.

Our know-how, based on 25+ years of experience, permits us to offer you in this web site

free advice about the usefulness of stem cell transplantation as a therapy of illness(es) that you, or your loved ones, suffer from, which you could get nowhere else on the Web, (click on "How to get SCT treatment" on the MENU bar, if you wish to learn more about this free service)

(Please, beware that stem cell transplantation is not a 'wonder' treatment for all diseases known to mankind, and so it may be of no use in your particular case.)

as well as a possibility to

order stem cell transplants manufactured by our company for actual patient treatment,

with worldwide delivery.

(Long distance consultation will soon be available via telemedicine link as well.)

Whenever you contact us on this web site in order to

get such a free advice via our online questionnaire,

we will respond promptly.

Besides that we assign each prospective client an ID code, so that there is no need to use the patient's name in future communications, or on vials containing the patient's stem cell transplants. The combined effect of such steps is that sensitive medical data will not get into the wrong hands.

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Copyright Stem Cell Transplantation Ltd.
Updated: August 2009

STEM CELL TRANSPLANTATION

CLIENT'S ORDER FORM