Testosterone Therapy Questionnaire From NovaGenix Jupiter, Florida

Testosterone Therapy Questionnaire

Take the A.D.A.M. quiz (Androgen Deficiency in Aging Males) to see if you may have signs of low testosterone. You’ll get your results instantly and we’ll follow up with you to discuss your concerns and available treatment options. (10 Questions - About 2 Minutes Total)
1. Do you have a decreased interest in "physical romance"?

YES NO
2. Do you have a lack of energy? (Especially compared to a few years back)

YES NO
3. Do you have a decrease in strength and/or endurance? Maybe a little more belly fat...less muscle definition?

YES NO
4. Have you lost height? You may be surprised as most men haven't check this out in a long time!

YES NO
5. Have you noticed a decreased enjoyment of life? Laughing less and not doing the same things you once used to love doing?

YES NO
6. Are you sad and/or grumpy? Finding less patience and having more mood swings?

YES NO
7. When its time to "perform", are you not as "rigid down stairs" as you once were? (You know, it still works just not as good)

YES NO
8. Have you noticed a recent deterioration in your ability to play sports or other physical activities?

YES NO
9. Are you falling asleep after dinner or work on the couch? Needing more "power naps"?

YES NO
10. Has there been a recent deterioration in your work performance? Or at home doing work around the house?

YES NO
Name

First Name Last Name
Email
example@example.com
Phone Number
Answering yes to questions 1 or 7 automatically qualifies that you may have testosterone deficiency (low testosterone). We'll contact you to setup lab testing and learn about your treatment options.
Want to learn more about Health Expressions?

Testosterone Replacement ED Treatments Weight Loss
By submitting this form you agree to receive limited communication from Refine Wellness Clinic about your results.Privacy Policy

Need Answers Now? Just Call or Text Us at 651-309-4300 for live help.
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