Apply for stem cell assessment Name Which part of your body to be treated? Where did you go for X-ray or scan (ultrasound or MRI)? Please upload the report or email me: drhassanmubark@gmail.com Date-of-birth NHI Gender MaleFemale Weight Phone number Email Address Any personal current or past history of cancer including skin cancer (give details please)? Any medical conditions and surgeries? What is your current medicines? Allergies to medicine and food? Name your health insurance? Emergency contact name and phone number Who is your GP and what is his practice name? Send
