Name How frequently do you experience the following symptoms? Decline In General Well Being * Never Rarely Sometimes Often Always Fatigue * Never Rarely Sometimes Often Always Joint pain/muscle ache * Never Rarely Sometimes Often Always Sleep Problems * Never Rarely Sometimes Often Always Nervousness / Anxiety * Never Rarely Sometimes Often Always Depressed Mood * Never Rarely Sometimes Often Always Declining Mental Ability/Focus/Concentraion * Never Rarely Sometimes Often Always Decreased muscle strength * Never Rarely Sometimes Often Always Weight Gain/Belly Fat/Inability to Lose Weight * Never Rarely Sometimes Often Always Rapid Hair Loss * Never Rarely Sometimes Often Always Are you experiencing any of the following conditions? Decreased desire/libido * Yes No Decreased Morning Erections * Yes No Do you have a family history of: Heart disease * Yes No Uncertain Diabetes * Yes No Uncertain Osteoporosis * Yes No Uncertain Alzheimer's disease * Yes No Uncertain Please fill out the information below and a member of our team will contact you to review your results. Phone Number * Email * Name * Comments Or Questions
