TRT Treatment Quiz & Consultation Request

Name

First

Last

Email

What is your biological sex?

Please select your age group

Are you currently experiencing any of the following symptoms? (Select all that apply)

Mood Swings or Irritability
Fatigue or Sleep Disturbances
Decreased Libido or Erectile Dysfunction
Memory Problems or Difficulty Concentrating
Weight Gain or Difficulty Losing Weight
Decreased Muscle Mass or Strength
Joint or Muscle Pain
Hair Loss or Thinning Hair

Have you ever been diagnosed with any of the following conditions? (Select all that apply)

Are you currently using any treatments or medications to manage your symptoms? (Select all that apply)

Herbal Supplements (e.g., Saw Palmetto, Ginseng)
Antidepressants or Anxiety Medications
Sleep Aids (e.g., Melatonin, Prescription Sleep Medications)
Pain Relievers (e.g., NSAIDs like Ibuprofen, Acetaminophen)
Erectile Dysfunction Medications (e.g., Sildenafil, Tadalafil)
Over-the-Counter Supplements (e.g., DHEA, Zinc)
Hair Loss Treatments (e.g., Finasteride, Minoxidil)
None of the above

How would you describe your overall lifestyle?

Sedentary
Moderately Active
Highly Active

How would you rate your current emotional well-being on a scale of 1 to 10?

Selected Value: 5

(1 being low and 10 being great)

How would you rate your current level of energy and motivation on a scale of 1 to 10?

Selected Value: 5

(1 being low and 10 being great)

How interested are you in learning more about HRT/TRT as a potential treatment option for your symptoms?

Very Interested
Somewhat Interested
Not Interested
Not Sure

Would you like to Schedule a Consultation Today?

Yes! I want to feel good today!
No, maybe another time

You will be redirected to schedule a risk-free personalized hormone therapy consultation. Reserve your spot for $24 at the end of this quiz!

Phone

This is the number we will call for your consultation

Consultation $24

Price: $24.00

the overall more

Pay with your Credit Card

Non-Refundable if you miss the appointment *The $24 will go towards your medication if you choose to move forward with your treatment, if you choose to not move forward with the treatment you can use the $24 as credit towards our supplements and vitamins

Subtotal	$0.00
Total	$0.00

Thank you. Your order has been received.