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  • Hormone Replacement Therapy Assessment

    Please fill out the following medical assessment as honestly and accurately as possible. This questionnaire helps us personalize your experience and determine your best course of treatment. It will take about 5 minutes. Your privacy is important to us, any information you provide is secure.

  • Do any of the following apply to you?

    • Severe Liver Disease or Liver Failure
    • Hormone Positive Breast Cancer in the last 5 years
    • Acute Cerebrovascular Accident (CVA)
    • Myocardial Infarction (MI)
    • Pulmonary Embolism (PE)
    • Deep Vein Thrombosis (DVT)
    • Currently Pregnant or trying to become Pregnant

  • Unfortunately, you are not a candidate for Hormone Replacement Therapy.

  • While you may not be a candidate for Hormone Replacement Therapy, we offer a wide variety of treatments that may be beneficial for you.


    Give us a call at 817-720-6320 if you have any questions or would like to schedule a consultation.


    You may also book online using our convenient online portal. 

    CLICK HERE TO BOOK ONLINE!

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  • Menopause Rating Scale

    Please rate the following symptoms you are currently or recently experiencing:
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  • ADAM Questionnaire

    If you are concerned that your testosterone levels are low, this set of questions is a good place to start.
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  • Sexual Health Inventory for Men Questionnaire

    This questionnaire will help us determine if you have symptoms of ED (erectile dysfunction). For each question, please select the number that approximates your belief.
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