offer-booking-assessment

1

What is your age group?* This field is required.

Under 30

Under 40

Under 50

50+

2

Do you have history with any of the following?* This field is required.

Heart disease

Liver or kidney disease

Cancer

Glaucoma

Blood clots / other blood conditions

None of the above

3

Do you experience any of the following symptoms?* This field is required.

Low sex drive / low labido

Fatigue or low energy

Decreased motivation or drive

Brain fog or trouble concentrating

Low mood or irritability

Poor sleep or frequent waking

None of the above

4

Are you currently taking prescribed TRT or anabolic steroids?* This field is required.

YESNO

5

Compared to 5 years ago, how has your physical performance changed?* This field is required.

No real difference

Slightly less drive and stamina

Noticeable drop-off in strength, recovery, or endurance

6

How would you describe your energy levels by mid-afternoon?* This field is required.

Stable & Normal

Still sharp and focused

Energy crashes hit hard by 2–3pm

7

Are you waking up tired, even after a full night’s sleep?* This field is required.

Yes, regularly

Occasionally

No

8

Has your sex drive changed?* This field is required.

No real change

Definitely less interest or consistency

No desire at all

9

Almost Done! How would you describe your lifestyle?* This field is required.(Select all that apply )

Work full-time or part-time with active lifestyle

Work full-time or part-time with non-active lifestyle

Not currently working, with active lifestyle

Not currently working, with non-active lifestyle

Retired

10

What is your name?* This field is required.

First Name

Last Name

11

Phone Number* This field is required.

example: 0431 xxx xxx

12

Last Step: Data & privacy* This field is required.

I consent to the collection, use, and secure handling of my personal health information for clinical assessment in line with Australian privacy laws.