Do you often feel down or irritable? *

Yes

No

Have you noticed a decreased enjoyment of life? *

Yes

No

Has it become harder to stay focused or productive at work? *

Yes

No

Has your performance at the gym decreased? *

Yes

No

Does it take longer to recover after workouts? *

Yes

No

Is it becoming more difficult to lose fat or build muscle? *

Yes

No

Do you have a lack of energy? *

Yes

No

Are you falling asleep after lunch or dinner? *

Yes

No

Do you have a decrease in libido (sex drive)? *

Yes

No

Are your erections less strong? *

Yes

No

First Name

Last Name

Phone

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