Name* First Name Last Name Email Address* Phone (###) ### #### 1. Have you noticed a loss of muscle mass, strength or endurance? YesNo 2. Are you getting a midline drift and are you having more trouble keeping the fat off? YesNo 3. Have you noticed a loss of self-confidence? YesNo 4. Do you have less interest in sex? YesNo 5. Do you feel depressed? YesNo 6. Do you feel less energetic than when you were 30? YesNo 7. Have you noticed fewer morning erections or do you have trouble getting an erection? YesNo 8. Do you find yourself having difficulty concentrating or focusing? YesNo 9. Do you have high blood pressure of high cholesterol? YesNo 10. Are you experiencing joint pain? YesNo How did you hear about us? GoogleFacebookTwitterInstagramYelpReferralOtherThank you!