Alpha Med Group Men’s Health Quiz

press the flag for

ENGLISH-SPANISH
MEN’S HEALTH QUIZ | SwissWave ®

This male health inventory is designed to help determine if you could be a good candidate for care based on a final severity score- which we will share with you after you submit it to the doctor. This should just take a minute to complete, and you receive an email voucher worth $300 off of your treatment plan, should you qualify for care today. -M|H Doctors ⚕️
Which of the following are you currently experiencing? *

Difficulty getting or staying firm Anxiety Low desire Curvature of the penis
For How Long?

Less than 6 months 6 Months to 1 year More than a year More than 5 years
Which treatment have you tried in the past?

None Pills Pump / VED Penile Injections or MUSE Testosterone Supplements P-Shot
Have you ever had any prostate surgeries? *

Yes No
Which benefits of shockwave therapy for ED interest you most?

Drug free treatment Reversing the root cause Pleasing my partner Improving sexual function
Almost done, Please prove you are real by scrolling selecting yes in the menu below. *
Great, next tell us where we should send your results.
Name *

First Name Last Name
Email *
example@example.com
Cell Number *

AREA CODE PHONE NUMBER
PRIVACY NOTICE

Alpha Med Group is committed to protecting and respecting your privacy, and we will only use your personal information to manage your account, give you information about the products and services you requested from us. You can unsubscribe from this list at any time for any reason with zero obligation. From time to time, we would like to contact you about your evolution, our products and services, as well as other content that may interest you.

Questions? Call Us- 727-977-8200

Email: help@alphamedgroupfla.com

Location:

2454 McMullen Booth Rd Ste 720

Clearwater, FL 33759
Should be Empty:

Now create your own Jotform - It's free! Create your own Jotform

MEN’S HEALTH QUIZ | SwissWave ®