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TPE Qualification Assessment

This assessment will help determine if Therapeutic Plasma Exchange (TPE) may be suitable for your unique health needs.

The assessment takes about 2-3 minutes. Complete the assessment to find out:

• If you are a candidate for TPE
• How TPE could help with your specific health goals
• Relevant TPE protocols and pricing

Important: This assessment is for informational or educational purposes only and does not replace professional medical consultation.

Patient Information

What is the approximate age of the patient?*

Is the patient currently pregnant?*

Is the patient able to follow simple commands and instructions?*

Is the patient able to walk and transfer (move from bed to chair, etc.)?*

Is the patient a paraplegic or quadriplegic?*

Has the patient had a stroke (CVA), heart attack (MI), congestive heart failure (CHF), or major surgery within the past 6 months?*

Does the patient have severe kidney disease (GFR less than 30)?*

Is the patient currently taking medications for ventricular arrhythmia (irregular heartbeat)?*

Is the patient currently taking seizure medications?*

Is the patient taking blood thinners for prevention of stroke, heart attack, or blood clots (DVT/PE)?*

Does the patient have severe hypersensitivity to therapy medications or clinical environments?*

Does the patient experience severe fatigue that significantly impacts their daily life?*

Does the patient suffer from severe mold toxicity or mycotoxin illness?*

Select all conditions and topics that are relevant to patient goals.*

Has the patient experienced any of the following?*

Is the patient also a health practitioner, physician, or doctor?*

What state/province is the patient located in?*