Refer a Patient

Eterna Health offers resources and information on regenerative medicine treatments. Complete our online Patient Referral Form to connect your patient with an Eterna Health Information Specialist. By submitting the form, you authorize us to access and use the patient’s medical information. Our specialist will contact the patient and provide resource information. Patient information is kept confidential, but names will be added to our mailing list for Patient & Community Outreach.

Patient referral form

Thank you for your referral.

Your Practice Name:

Your Medical License #:

Referral’s First Name:

Referral’s Last Name:

Referral’s Email:

Referral’s Phone #:

Referral’s Problem Area:

World-leaders in regenerative medicine.

We are leading the way in the medical revolution and will continue to evolve until illness based treatments are replaced by wellness based solutions.

We have proprietary procedures & protocols that have been developed from our experience in North America, Europe, Asia and the Middle East.