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Screening Application Form

Initial Screening

The initial screening form will allow us to determine if you are a good candidate to begin the pre-treatment process. Most applications will receive a response within 72 hours.

Intake Forms

If accepted you will receive a link to complete your medical history forms. Once completed you will receive a list of labs / exams that must be completed prior to treatment.

Packet Review

Once your forms, medical history, and labs / exams have been submitted for review, our medical team may provide final clearance.

Schedule Treatment

Once approved, you may book your treatment on your desired date, subject to availability.

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Screening Application Form

Please complete this brief online application to find out if you are a suitable candidate for our stem cell protocol located in Seri Kembangan Centre.

CELLAAX SDN BHD is PDPA Compliant.  Your information will not be shared with any third parties. Your information will only be used to determine your candidacy for treatment. Treatment approval subject to pre-treatment lab results and final review conducted by our medical team.

logo CELLAAX aboutus

Screening Application Form

Please complete this brief online application to find out if you are a suitable candidate for our stem cell protocol located in Seri Kembangan Centre.

CELLAAX SDN BHD is PDPA Compliant.  Your information will not be shared with any third parties. Your information will only be used to determine your candidacy for treatment. Treatment approval subject to pre-treatment lab results and final review conducted by our medical team.