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Hormone Therapy Assessment for Men


Please take the following assessment that can help determine your need for hormone therapy. All fields are required.


Please Complete

Please answer all questions:
Enter your name
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Enter your gender
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1.) I am having a problem achieving an erection.

                                           

2.) I feel more tired and exhausted. I do not do the things I used to like to do as often.

                                           

3.) I am gaining fat or have lost muscle or strength.

                                           

4.) I am losing energy and can't exercise like I used to.

                                           

5.) My erections are not as strong as they used to be.

                                           

6.) I am more irritable, even short tempered more often.

                                           

7.) It is getting more difficult to concentrate or hear or see clearly.

                                           

8.) I may fall asleep during the day or earlier than I used to at night.

                                           

9.) My skin looks thinner and more wrinkled or blemished.

                                           

10.) I forget numbers, names, and everyday things more often.

                                           

Please provide the following:

Select the preferred time for a FREE review with a
patient representative:

        

When we receive your results we will place $50.00 on
your account towards a first visit with us!