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Application For Stem Cell Treatment Of Alopecia Areata - Adult

To initiate the application process for Throne's cord blood stem cell treatment targeting Alopecia Areata, kindly complete the following application.
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Your Name
Your Address
Have You Been Diagnosed With Alopecia Areata?
Is There A Family History Of Alopecia Areata?
If Your Alopecia Areata Has Been Diagnosed Using The Severity Of Alopecia Tool ("SALT"), Enter Your Most Recent Classification Under That Tool (If you need to see how to calculate your SALT score, see next below)
Do You Want To See How To Calculate Your SALT Score? CLICK HERE
Do You Have Any Of These Other Autoimmune Disorders? Check All That Apply.
Email Communication Authorization: I give permission for Throne Biotechnology And Its Doctors To Communicate With Me Regarding My Care By Telephone, Text Message, or Email.
Required HIPPA Privacy Practices Notice (To See A Copy Of Our HIPPA Privacy Practices, See The Next Paragraph)
Click here to review our HIPPA Privacy Policy.

Thank you for your interest in the Throne Stem Cell Treatment. We will respond to your application within the next two business days.

Throne Biotechnologies, 10 Forest Avenue, Suite 110, Paramus, NJ 07652