How would you rate your daily energy levels?

High and consistent

Average, but I have dips

Low and hard to get going

Exhausted most of the time

How’s your libido (sex drive)?

Strong

Occasional interest

Noticeably decreased

Nearly gone

Are you struggling to build muscle or lose fat despite working out or eating well?

Yes

No

Haven’t tried recently

Do you have trouble focusing or feel mentally foggy?

Often

Occasionally

Rarely

Not at all

Have you noticed changes in your mood, motivation, or confidence?

Yes, I feel off

A little bit

No, I feel like myself

Are you interested in having your hormone levels reviewed by a licensed provider?

Yes, I’d like to know more

Maybe, tell me what’s involved

Not right now

What’s your top health goal right now?