contact
* REQUIRED FIELDS. FOR PATIENTS WITH DIABETES
FIRST NAME*
LAST NAME *
EMAIL*
ADDRESS
CITY
STATE
ZIP
COUNTRY
PHONE
 
 
How long have you had insulin dependent diabetes?
How many insulin injections do you take each day?
Do you feel you are able to maintain good glucose control without the risk of hypoglycemia?
Do you have any complications at this time? If so, what are they?
Would you be willing to use multiple daily injections of a therapy that would have the potential to regenerate insulin producing cells- ---“turn back the clock” in the progression of diabetes?
Would you be interested in learning more about regeneration therapy?
Are you intersted in particpating in the clinical trials?
ADDITIONAL COMMENTS: