Do you have less sex drive or function than before? 

Are your erections sometimes weeker? 

Do you have less energy than you used to? 

Have you noticed less drive and competitiveness at work or in recreational activities? 

Are you happy and excited less often? 

Do you have more generalized aches and pains? 

Do you experience more fatigue in the evenings? 

Do you have increased mood swings? 

Are you gaining abdominal fat or losing muscle mass? 

Have you noticed slowing thinking or recall? 

Let us know what your particular symptoms are:

Would you like to be contacted for a free consultation to discuss your individual 
symptoms and potential solutions? 

If Yes, what is the best number to reach you?

If Yes, when is the best time of day to call you?

If Yes, what dates are best for a consultation?
Return to Home Page

Andropause Survey
Last Name:
Email Address: 
Daytime Phone Number: 
-
-
First Name: 
-
-
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo