Take this free symptom checker form to help us understand how best to address your concerns.Once the form is submitted, one of our medical staff members will follow up at a time convenient to you. Male Health Assessment Name* First Last Email* Phone*When is it the best time to call?*What is your age?Symptom CheckerPlease check any symptoms that are issues you would like addressed.Loss of Energy/Fatigue Yes No Irritable Yes No Depressed Yes No Loss of Sex Drive Yes No Erectile Dysfunction Yes No Loss of Drive and Competitive Edge Yes No Decreased Effectiveness of Workouts Yes No Stiffness and Pain in Muscles and Joints Yes No Weight Gain/Inability to Lose Weight Yes No Foggy Thinking Yes No Poor Memory Yes No Feel Cold Yes No Dry Skin/Hair Yes No Diffuse Pattern Hair Loss Yes No Male Pattern Hair Loss Yes No Insomnia- falling Asleep Yes No Insomnia- staying Asleep Yes No Stress Yes No Night Sweats Yes No Loss of Motivation Yes No Feel Overwhelmed Yes No Lack of Confidence Yes No Loss of Motivation Yes No Feel Overwhelmed Yes No Sugar Cravings Yes No Craving Salty Food Yes No This field is hidden when viewing the formCraving Salty Foods Yes No Water Retention/Swelling Yes No Oily Skin/Acne Yes No Breast Tenderness Yes No Please describe any other health concerns you may have or questions about services.Consent* I agree to the privacy policy.IMPORTANT: Your privacy and confidentiality are important to us. By submitting data to us and/or using our website, you give your consent that all personal data that you submit will be processed in the manner as described by the following Privacy Policy.PhoneThis field is for validation purposes and should be left unchanged.
