Most patients arriving for their first Apex consultation have been to two or three other clinicians before us. Some have already been quoted protocols at other clinics. Some have been told nothing can be done. Some are at the point where they're seriously considering joint replacement and want a second opinion before they schedule it.

The first visit is structured the same way for all of them. This guide walks through exactly what to expect, what to bring, and how to use the visit well.

The 30,000-foot view

Apex consultations run 60 to 90 minutes. They include a full history, a focused exam, imaging review with you in the room, a discussion of options, and a written plan. You leave with documentation in hand. If you decide to proceed, treatment is scheduled at a later visit. You don't sign a treatment consent the same day as your consultation.

The flow is structured because we found, after running it less formally for a while, that patients made better decisions when we slowed down the recommendation step. Same-day "here's your protocol, here's the deposit form" feels efficient but produces a meaningful number of patients who regret the decision a week later. The deliberate gap between consultation and treatment is part of the practice.

Before you come in

When you book a consultation, our intake team will send a short health history form and ask you to upload:

Recent imaging (MRI, X-ray, ultrasound). Disc, PDF, or patient portal link all work. If you have images going back several years, send them too. The progression over time often matters more than any single study.

Recent labs if you have them. Particularly any inflammatory markers, metabolic panel, lipid panel, HbA1c, thyroid, and vitamin D. If you have a recent uric acid level, send that. Anything else relevant to systemic inflammation or your overall health.

A list of medications, supplements, and known allergies.

Notes from any prior injections, surgeries, or PT. Specifically: what was injected (steroid, hyaluronic acid, PRP, stem cells, something else), into what structure, by whom, when, and what the response was.

The intake team will confirm the visit and let you know if there's anything else useful to bring.

We review the materials before you walk in. The visit shouldn't start with you handing me a stack of papers and waiting while I read.

If you can't get the imaging together before the visit, come anyway. We have radiology relationships in the area and can usually arrange same-day or next-day imaging if needed.

What to bring

A short physical list:

  • Photo ID for check-in.
  • Insurance card (we don't bill for procedures, but we may submit imaging or labs under your insurance, which often does cover those services).
  • Imaging on disc or your patient portal login if you haven't already shared it.
  • A printed list of medications and supplements. We've all become bad at remembering everything we take.
  • A short written note of the questions you most want answered. Patients often forget half their questions in the room. Pre-writing them helps.
  • One sentence describing your goal. "I want to walk to the mailbox without pain by Christmas" or "I want to play with my grandkids without flaring up for three days afterward" or "I want to delay knee replacement by three years." Specific goals drive specific protocols.

A second pair of ears if you have someone you trust. A spouse, an adult child, a friend. Decisions made about your own joints while you're hurting are easier with another listener in the room.

The check-in and initial questions

You'll check in with our front desk. The intake forms will be confirmed, and a medical assistant will walk you to the consultation room. Vitals get taken. Brief screening questions get asked.

The visit itself opens with me coming in, sitting down, and asking what brought you here. Not "what's wrong," but "what brings you here today and what are you hoping we can help with." The framing matters. It opens the conversation to your goals, not just your symptoms.

The first ten minutes are usually you talking. I listen, I take notes, I ask occasional clarifying questions. I want to understand:

When the problem started. Sudden onset, gradual onset, or an acute injury layered on a chronic baseline.

What makes it better and worse. Activity, rest, weather, time of day, specific motions.

What you've tried and how each thing worked. Including the things that didn't help.

What "better" would look like to you. The functional outcome that would make this worth your time and money.

Your overall health context. Other medical conditions, surgeries, family history. We're treating a joint or a tissue, but we're treating it in the context of you as a person.

This phase can run 20 to 30 minutes if there's a lot of history. Don't worry about taking my time. The history is where most of the diagnostic information lives. Skipping or rushing it produces worse recommendations.

The exam

Targeted to the indication. The exam isn't a head-to-toe physical, it's a focused musculoskeletal evaluation of the structures relevant to your case, with screening of related areas that might be contributing.

For a knee, we'll typically check:

Range of motion, both passive and active.

Ligamentous stability (anterior drawer, posterior drawer, valgus and varus stress, Lachman, pivot shift).

Meniscal signs (McMurray, Apley, joint line tenderness).

Patellofemoral evaluation (grind test, apprehension).

Gait analysis.

Hip and ankle screen, because knee pain often has hip and ankle contributors.

A focused neurologic check if there's any radicular component.

For a shoulder:

Full range of motion screening.

Rotator cuff strength testing (empty can, Hornblower, external rotation strength).

Impingement signs (Neer, Hawkins-Kennedy).

Labral provocation (O'Brien, anterior slide, Speed's).

Acromioclavicular evaluation.

Cervical spine screening, because shoulder pain often has cervical contributors.

For spine:

Range of motion in all planes.

Provocation maneuvers (FABER for SI, Spurling for cervical, slump test, straight leg raise).

Full neurologic exam (motor, sensory, reflexes, gait).

Palpation of suspected pain generators.

For other indications, the exam adapts accordingly. The exam usually takes 10 to 15 minutes. I narrate findings as we go, so you understand what I'm checking and why.

The imaging review

This is the part most patients have never experienced before, and it's often the most useful part of the visit.

We pull your imaging up on a clinical monitor and walk through it together. Not "the radiologist said you have moderate osteoarthritis," but actually showing you the joint, the structures, the findings, and what they mean. You see what I'm seeing. I explain what's normal, what's abnormal, and what's relevant to the decision in front of us.

For a typical knee MRI, we'd look at:

The cartilage on the femur and tibia, separately. Where is it thinned, where is it preserved.

The menisci. Tear pattern if present. Extrusion if present.

The bone marrow. Edema patterns, cysts, sclerosis.

The synovial lining. Thickening, effusion.

The ligaments and tendons around the joint.

Any incidental findings that change the picture.

For a typical shoulder MRI we'd look at the rotator cuff (each muscle separately), the labrum, the long head of biceps, the AC joint, and the bone.

For spine we'd look level by level: disc heights, hydration, herniations, facet hypertrophy, ligamentum flavum thickening, central canal and foraminal dimensions, alignment.

This phase usually runs 15 to 20 minutes. Patients sometimes get emotional during it; the first time someone explains your own anatomy in detail, in a way that matches the symptoms you've been living with, can be unexpectedly grounding. Others find clarity for the first time. A few are reassured to learn the findings are less dire than they'd assumed.

This is also where we sometimes catch findings that change the conversation. An unsuspected meniscal tear. A labral issue we'll want to address differently. A degenerative change that makes a particular protocol the wrong tool. Less commonly, an incidental finding that needs a separate workup (a suspicious bone lesion, a renal finding on a spine MRI, a thyroid nodule on a cervical MRI).

The discussion and the written plan

After the imaging review, we sit down together and walk through the options.

I'll tell you which category I think you fall into:

  • Conservative therapy is still the right next step (PT, weight management, activity modification, conservative injection).
  • A regenerative protocol is appropriate, and here's the specific protocol.
  • A regenerative protocol could work, but we'd need additional workup first (labs, second imaging, second opinion from a related specialty).
  • A surgical consultation is the right next step. Cells won't address what your imaging shows, and trying to treat it regeneratively wouldn't be right.
  • A combination: surgical opinion plus regenerative consideration as either alternative or adjunct.

If I recommend a regenerative protocol, the plan will include:

The specific modality (PRP, stem cells, exosomes, combination).

The joint or site, with image-guidance plan.

The cell or growth-factor dose.

The expected timeline for response.

The follow-up schedule.

The cost, in dollars, with what's included.

What we'll consider a treatment success and a non-response.

What we'll do at re-evaluation if you don't respond as hoped.

This goes into a one or two page written plan that you take home.

If I recommend against treatment, the plan will include why, what I think the right next step is, and (if relevant) the names of clinicians or specialties I'd refer you to.

A sample written plan (anonymized)

For illustration, here's roughly what a typical knee OA stem cell plan looks like in written form:

Patient. [Name], DOB [date], MRN [number] Date of consultation. [date] Indication. Right knee osteoarthritis, Kellgren-Lawrence grade III, medial compartment predominant. Confirmed on MRI [date] and weight-bearing X-ray [date]. Failed 6 weeks of PT, two corticosteroid injections at 9 and 14 months ago with progressively diminishing response. Recommended protocol. Allogeneic umbilical MSC and exosome combination, image-guided intra-articular injection, right knee. Cell dose. 2.0 x 10^7 viable umbilical MSCs, plus MSC-derived exosomes per standard adjunct protocol. Cell product from [processor name], lot [TBD]. Image guidance. Ultrasound, real-time visualization of needle tip in intra-articular space, with image documentation saved to chart. Procedure date. To be scheduled 2 to 4 weeks from today. Post-procedure plan. Reduced loading for 7 days. No NSAIDs for 5 days. Acetaminophen and ice as needed. Light walking encouraged. No high-impact activity for 4 weeks. Return to baseline activity gradually over weeks 4 to 8. Follow-up. - 6 weeks (in-person, with pain and function scores) - 12 weeks (in-person, with formal outcome assessment) - 6 months (in-person, peak-effect assessment) - 12 months (decision visit re: maintenance) Expected timeline. Mild post-procedure soreness 24-72 hours. Improvement starting weeks 6-8. Continued improvement through months 4-6. Peak effect at 6-12 months. Success criteria. 50%+ reduction in pain at 12 weeks; functional improvement on WOMAC; sustained at 6 months. Non-response plan. If less than 25% pain improvement at 12 weeks, we will re-evaluate imaging, consider whether mechanical contributors warrant surgical referral, and discuss alternate or adjunctive protocols if regenerative therapy still appears appropriate. Cost. $6,200, includes consultation, procedure, image guidance, cell and exosome product, and all follow-up visits through 12 months. Imaging and labs billed separately to insurance. Alternatives discussed. PRP series (lower cost, lower expected effect at this OA grade); total knee replacement (definitive structural option, longer recovery, different decision); ongoing conservative care without injection.

You leave with this in hand. We don't expect you to decide at the visit. Most patients decide within one to two weeks.

What happens after

If you decide to move forward, we schedule treatment separately, usually within 2 to 4 weeks. That gap is intentional. We want you to think about the decision when you're not sitting in our office.

If you decide not to move forward, that's a normal outcome. We'd rather have you reach out two years from now after thinking it through than have you say yes today and regret it.

If you're somewhere in between and want a second consultation, we'll schedule one. We don't charge for follow-up consultation calls related to a decision you're working through.

If you decide to seek a second opinion at another clinic, we'll send your records over and welcome the additional input. We're not threatened by competent second opinions; we benefit from them, because patients who've shopped multiple credible options arrive more committed once they make a decision.

For patients flying in

Apex sees a meaningful number of patients from outside Texas. For visitors traveling to us, the flow is slightly different:

We try to do the consultation, the workup, and the treatment in a structured visit window, typically Monday-Tuesday-Wednesday or Thursday-Friday-Monday with a weekend in between.

Pre-visit imaging review is more rigorous, because we want to know before you fly in whether you're likely to be a candidate.

We arrange local accommodations and transportation guidance as part of the visit. The clinic is about 25 minutes from DFW airport.

Post-visit follow-up is handled by structured telehealth visits at 6 weeks and 12 weeks, with in-person follow-up timed around any return trip you plan.

If something during pre-visit review suggests you're not a candidate, we tell you before you book travel.

What you should bring to the room emotionally

A practical note for patients who are at the end of their patience with the medical system.

A consultation works best when you bring three things:

Honesty about your goals and what's worth what to you. Patients who hide their actual goals end up with protocols built for the goals they implied. Tell us what you really want.

A willingness to hear no. Some patients come hoping we'll confirm a decision they've already made. If the right answer is different, we'll say so. If you can hear that without it derailing the visit, the visit is more useful.

Patience for the long game. Regenerative protocols play out over 6 to 12 months. Treatment is a beginning, not a finish line. Patients who arrive expecting a one-shot fix are often disappointed even when the protocol works, because the timeline doesn't match their expectation. We try to set that expectation up front.

Common emotions in the consultation room

Patients sometimes arrive with frustration accumulated from multiple prior providers. That frustration is real and often justified, but it can also color how the consultation goes. A few patterns we see and how we try to handle them:

The patient who's been dismissed by multiple specialists. We hear "they told me there was nothing to be done" or "they told me I was just getting older." We take the complaint seriously, look at the imaging, and tell you what we see. Sometimes the prior providers were right and the right answer really is surgical or conservative. Sometimes they missed something. We don't pre-judge.

The patient who's been oversold elsewhere. The other side of the same coin: patients who've been quoted improbably ambitious protocols at other clinics and want a sanity check. We give one. Honestly, even when the result is "yes, what they suggested could work" or "actually, what they're suggesting is overkill for your case."

The patient who's exhausted and just wants a decision made for them. We can't make it for you, but we can give you the cleanest version of the recommendation and the cleanest version of the alternative, so the decision is easier to make.

The patient who wants to talk us into something we don't think they need. Sometimes patients arrive having convinced themselves that cells are the answer regardless of what we say. We say what we'd say to a member of our own family, even if you don't want to hear it.

A note about consultation fees

We charge a flat consultation fee that's posted on our pricing page. The fee is the same whether you become a treatment patient or not. We do this on purpose. The structure removes any incentive to recommend a protocol to a non-candidate, which is the single most common failure mode of this industry.

If we're not the right clinic for you, the consultation fee buys you a credentialed second opinion, written documentation, and (usually) a recommendation for the right next step elsewhere. That's worth what we charge.

How to book

To request a consultation: use the booking form at /#consult or call (972) 768-2328. We're at 2111 Kirkwood Blvd, Suite 110b, Southlake, TX 76092.

If you're traveling from out of state and want to discuss the visit before booking flights, let our intake team know on the form or in the call. We'll work the visit timing around your travel.

A short note from Dr. Abdullah

The visit is the most important thing we do. The procedure that follows it, when there is one, is the easier part. The hard part is figuring out which procedure (if any) is the right tool, in the context of your specific imaging, your specific goals, and your specific overall picture. That's what 60 to 90 minutes of focused attention is for. We try to make it the highest-quality medical conversation you've had in a long time. Most patients tell us afterward that it was.