Hormone Health Consultation Interest Form
Provide your details and preferences to help us understand your needs and guide you to the right next steps.
What prompted your interest in a hormone health consultation?
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Fatigue / low energy
Weight gain or difficulty losing weight
Poor sleep
Brain fog or trouble focusing
Mood changes / anxiety / or irritability
Low libido
Perimenopause / menopause symptoms
Low testosterone concerns
Muscle loss or poor recovery
Preventive / proactive health
Other
How long have these symptoms been affecting you?
*
Less than 3 months
3–12 months
1–3 years
More than 3 years
Have you had hormone-related testing in the past?
*
Yes
No
Unsure
If yes: You may upload labs or bring them to your visit.
What best describes what you are hoping for?
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I want to better understand what may be contributing to how I feel
I want a thoughtful discussion about hormones and treatment options
I am interested in hormone replacement therapy/testosterone
I am looking for a whole-person approach beyond hormones
I'm not sure — I just know I don't feel like myself
Have you worked with any of the following before?
Primary care physician
OB/GYN
Endocrinologist
Functional medicine provider
Hormone clinic
None of the above
Are you comfortable with a consultation that may include recommended testing and follow-up visits?
*
Yes, I'd like more information
Unsure
Are you currently a member of Direct Primary Care of West Michigan?
*
Yes
No
What is your biggest concern or goal right now?
*
Submit
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