Male Health Assessment

Gentlemen: Begin Your Journey

Congratulations on taking the first step toward reclaiming your vitality and well-being. This test marks the start of your path to a healthier, enhanced version of yourself. Let us know if you've been experiencing any of the following symptoms, and together, we'll pave the way to your improved health.

Take The Male Health Assessment Survey

First Name

Last Name

Phone *

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Symptoms

Please mark the appropriate box for each symptom you may be experiencing.

Physical Exhaustion (fatigue, lack of energy, stamina or motivation)

Sleep Problems (difficulty falling asleep or sleeping through the night)

Irritability (mood swings, feeling aggressive, angers easily)

Anxiety (feeling overwhelmed, feeling panicky, or feeling nervous)

Decline in drive or interest (loss of “zest for life,” feeling down or sad)

Joint and muscular symptoms (joint pain, muscle weakness, poor recovery after exercise)

Difficulties with memory (concentration, finding the right word, or retaining information)

Sexual Desire or Performance (reduced or diminished)

Erectile changes (weaker erections, loss of morning erections)

Ejaculations (infrequent or absent)

Sweating (night sweats or increased episodes of sweating)

Hair loss, thinning or change in texture of hair

Feeling cold all the time, having cold hands or feet

Headaches or migraines (increase in frequency or intensity)

Weight (difficulty losing weight despite diet/exercise)

Bladder problems (difficulty in urinating, increased need to urinate, incontinence)

Other symptoms or unique health circumstances to take into consideration:

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