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Please Fill Out Your Medical History

What is the main reason you're wanting testosterone?

Fatigue

Stressed

Erectile Disfunction

Other

Have you taken Testosterone before?

Yes

No

Are you currently taking any other medication?

Yes

No

Did you suffer any major injuries in the past 6 months?

Yes

No

Are you afraid of needles?

Yes

No

Any Other Medical History You Would Like For Us To Know?

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All Medical Care Should Include A Physical Exam By Your Primary Physician. If You Want Us To Do Your Physical Exam, We Can Arrange To Have It Done At Our Office

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