IS HORMONE REPLACEMENT THERAPY
FOR YOU?

    FIND OUT TODAY!

    First Name:

    Last Name:

    Phone Number:

    Email:

    MaleFemale

    Date of Birth:

    Height:

    Weight:

    How Did You Hear About Us?

    DO YOU HAVE LOW TESTOSTERONE (LOW T)?

    Is your sex drive not what is used to be? YesNo

    Are your erections weaker? YesNo

    Do you have a lack of energy? YesNo

    Have you noticed reduction in strength or cardiovascular condition? YesNo

    Are you experiencing more injuries or muscle and joint aches? YesNo

    Are you always feeling tired? YesNo

    Has your strength and/or endurance lessened? YesNo

    Are you experiencing increased belly fat? YesNo

    Are you sluggish in the morning? YesNo

    Are you more irritable, depressed or sad? YesNo

    Are you fatigued more easily during exercise? YesNo

    Has your work performance suffered? YesNo

    Are you getting less restful sleep? YesNo

    Have you noticed a decreased drive or motivation? YesNo

    Have you noticed slower mental function and memory loss? YesNo

    A specialist will contact you with your results.