Home
Testosterone Replacement
ED Treatments
Hair Restoration
Blog

Select Page

Male Health Assessment

Take this free symptom checker 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.

"*" indicates required fields

Name*

First Last

Email*

Phone*

When is it the best time to call?*

What is your age?*

Symptom Checker

Please check any symptoms that are issues you would like addressed.

Loss of Energy/Fatigue

Yes

Irritable

Yes

Depressed

Yes

Loss of Sex Drive

Yes

Erectile Dysfunction

Yes

Loss of Drive and Competitive Edge

Yes

Decreased Effectiveness of Workouts

Yes

Stiffness and Pain in Muscles and Joints

Yes

Weight Gain/Inability to Lose Weight

Yes

Foggy Thinking

Yes

Poor Memory

Yes

Feel Cold

Yes

Dry Skin/Hair

Yes

Diffuse Pattern Hair Loss

Yes

Male Pattern Hair Loss

Yes

Insomnia- falling Asleep

Yes

Insomnia- staying Asleep

Yes

Stress

Yes

Night Sweats

Yes

Loss of Motivation

Yes

Feel Overwhelmed

Yes

Lack of Confidence

Yes

Loss of Motivation

Yes

Feel Overwhelmed

Yes

Sugar Cravings

Yes

Craving Salty Food

Yes

This field is hidden when viewing the form

Craving Salty Foods

Yes

Water Retention/Swelling

Yes

Oily Skin/Acne

Yes

Breast Tenderness

Yes

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.

Comments

This field is for validation purposes and should be left unchanged.