Select a choice (required)
*
Male
Female
Have you noticed a loss of muscle mass, strength, or endurance? (required)
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Yes
No
Are you having more trouble than usual keeping weight off? (required)
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Yes
No
Do you feel like you've lost your self-confidence? (required)
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Yes
No
Has your interest in sex diminished? (required)
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Yes
No
Do you ever feel depressed? (required)
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Yes
No
Do you have less energy than when you were 30? (required)
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Yes
No
Do you have trouble getting an erection? (required)
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Yes
No
Do you struggle more than ever controlling your temper? (required)
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Yes
No
Do you have difficulty concentrating or focusing? (required)*
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Yes
No
Do you ever have hot flashes? (required)
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Yes
No
Do you ever have night sweats? (required)
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Yes
No
Do you ever feel more stressed / anxious / nervous than usual? (required)
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Yes
No
Have you gained weight in your abdomen, hips, buttocks, or thighs? (required)
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Yes
No
Do you have a hard time sleeping? (required)
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Yes
No
Do you find it harder to remember things? (required)
*
Yes
No
Do you often feel depressed? (required)
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Yes
No
Have you lost your interest in sex? (required)
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Yes
No
Do you often feel irritable, angry, or impatient? (required)
*
Yes
No
When you cough or sneeze, do you sometimes have urinary leakage? (required)
*
Yes
No
Email
*
Full Name
*
Phone
*
Date of birth
*
How did you find out about us?
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How did you find out about us?
I was referred by someone
Outdoor advertising
Online search/ Online advertising
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