Contact Info
Full Name
*
Email
*
Phone Number
*
Symptoms
*
Low energy
Brain fog
Weight gain
Etc
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Age Range
*
Enter Your Age
Libido & ED Screening
*
Libido changes
Erectile quality
Hair Loss Screening
*
Thinning
Shedding
Receding
Lifestyle
*
Exercise
Diet
Sleep
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Medical History
*
BP
Cholesterol
Liver
Prostate
PSA
Current meds
Prior TRT use
Fertility Status
*
Yes
No
Plan to have kids?
Goals & Readiness
*
Energy
Fat loss
Libido
Etc
How soon do you want to start?
Immediately
Within 1–2 Weeks
Within a Month
Just Exploring
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