Patient Information Packet Request – oreme - Next-Generation, Non-Invasive Orthopedic Regenerative Medicine in Europe

Phone

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Name*

Prefix First Last

Current country of residence*

Country

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Have you previously had a Regenexx treatment?

Yes
No

Please explain your past Regenexx treatment in more detail (What was treated? In which Regenexx clinic?)*

Please select your primary problem area:*

Do you have other problem areas?*

Yes
No

Please select your secondary problem area:*

Do you have a third problem area?*

Yes
No

Please select your third problem area:*

Do you have a fourth problem area?*

Yes
No

Please select your fourth problem area:*

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(Archive) Please select your secondary problem area(s):

Knee
Hip
Shoulder
Spine
Hand / Wrist / Finger
Foot / Ankle / Toe
Elbow
Other

Please provide further information or a diagnosis concerning the problem area or condition for which you are considering treatment (e.g. arthritis, tendonitis)*

Are you in possession of an MRI of the affected area(s) (no older than 6 months)?*

Yes
No

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Please note: our clinic's MRI referrals (for patients outside Belgium) might not be covered by your national health insurance. Please tick the box to indicate that you have read and accept to bear the costs should any be incurred. *

I understand that your procedures are not covered by insurance (please tick the box to confirm). *

Email*

Enter Email Confirm Email

Phone number*

Please include your local area code (without a preceding "0")

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Upon submitting this form, you will be contacted by an Oreme-Regenexx agent. Would you like them to first get in touch with you by phone?

Yes - Please call me
No - Email only for now

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When is typically the best time to reach you?

9:00 - 11:00 (GMT +1)
11:00 - 13:00 (GMT +1)
13:00 - 16:00 (GMT +1)

Anything else you feel is important? Enter your message here

Please tell us how you found out about Oreme

Any source in particular?

* indicates a required field.

Mon-Tue:	08:00 - 16:00
Wed:	08:00 - 13:00
Thu:	08:00 - 16:00
Fri:	08:00 - 12:00

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Holistic orthopedic treatment

Oreme

Opening Hours