Andropause Survey

Are you losing your energy, memory or libido? You could be losing your Testosterone. We can help get your energy, memory and sex drive back.

Our Hormonal Health Assessment was carefully designed to provide you with a free clinical review of your personal hormonal status.

Submit your survey
Get $50 off
 your first visit!

Are you losing your energy, memory or libido?

You could be losing your vital Testosterone, and have poorly functioning adrenal and thyroid glands.

We can help get your energy, memory and sex drive back.

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
Enter your phone number
Enter your age
Enter your gender
Please select a time
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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!