BHRT Quiz for Men

Complete the Hormone Wellness Quiz to get a better understanding of whether you are a good candidate for Bio-identical Hormone Replacement pellet therapy. Camille will review your answers and contact you with recommendations.

    YOUR SYMPTOMS:

    FATIGUE
    Not An IssueMildModerateSevere

    MOOD CHANGES
    Not An IssueMildModerateSevere

    DECREASED MENTAL ABILITY
    Not An IssueMildModerateSevere

    EXCESSIVE SWEATING
    Not An IssueMildModerateSevere

    WEIGHT GAIN
    Not An IssueMildModerateSevere

    DECREASED SEX DRIVE
    Not An IssueMildModerateSevere

    SLEEP PROBLEMS
    Not An IssueMildModerateSevere

    COLD HANDS & FEET
    Not An IssueMildModerateSevere

    DECREASED MUSCLE STRENGTH
    Not An IssueMildModerateSevere

    HAIR LOSS
    Not An IssueMildModerateSevere

    JOINT PAIN
    Not An IssueMildModerateSevere

    FAMILY HISTORY:

    Check all that apply.

    Heart DiseaseDiabetesOsteoporosisAlzheimer's DiseaseProstrate CancerN/A

    CONTACT INFO:

    We will review your answers and contact you with recommendations.

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