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Cell Banking Agreement

Banking Stem Cells can provide treatment options including:

  • Current uses of stem cells include arthritis, and soft tissue injuries (tendon and ligament).
  • Future uses of stem cells may include treatment of kidney, liver, heart, and immune mediated diseases.

One fat collection can provide a lifetime of stem cell therapy by utilizing stored doses and/or cell culturing. Culturing of stem cells and processing of stored doses will incur costs. Consult your veterinarian for estimates of potential future costs for treatment.


Cell Banking Acceptance or Refusal

Please Choose an Option:
Yes - I wish to bank cells for my animal for 1 year for $150

Yes - I wish to bank cells for my animal for 3 years for $350

Yes - I wish to bank cells for my animal for 5 years for $500
  * All prices quoted in US Dollars

No - I do not wish to bank cells for my animal. I agree to donate and thereby relinquish all rights to, and associated with, my Animal's remaining stored cells. I authorize VetStem to use the remaining stored cells from my Animal for training and ongoing development of the technology.

No - I do not wish to bank cells for my animal. Please Dispose of all cells

Contact Information (please complete so that we have current information)
Animal Name:*

Species:

Owner First Name:*

Owner Last Name:*

Owner Address:*

Address 2: (Suite or Apt#)

City:*

State:

-OR- Province:
Country:*
Postal Code:*

Phone:

Cell Phone:

Email:*

Comments or Questions:


Your paid invoice will be emailed to you for your records.

Cell Banking Agreement

Yes, I Agree to the Terms

Payment Method (please select payment method and renewal option)
Pay by Credit Card:

Payment by Check: Include check with this authorization form


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12860 Danielson Court, Suite B, Poway, CA 92064 Phone: 858-748-2004 or 888-387-8361