Men's Hormone Testing | Hormone Health Grand Junction

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(970) 812-5115

Men's Hormone Test

Men's Hormone Test

Take this test to help us assess how bioidentical hormone replacement might benefit you.

Last Name

First Name

Phone *

Email *

Do you feel depressed?

Do you feel depressed?
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No
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Have you noticed a loss of self-confidence?

Have you noticed a loss of self-confidence?
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Do you have less interest in sex?

Do you have less interest in sex?
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Do you have joint pain?

Do you have joint pain?
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No
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Have you noticed fewer morning erections or do you have trouble getting an erection?

Have you noticed fewer morning erections or do you have trouble getting an erection?
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No
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Do you find yourself having difficulty concentrating or focusing?

Do you find yourself having difficulty concentrating or focusing?
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Have you noticed a loss of muscle mass, strength, or endurance?

Have you noticed a loss of muscle mass, strength, or endurance?
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Do you feel less energetic than when you were 30?

Do you feel less energetic than when you were 30?
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Do you feel irritable, angry, or impatient without control of emotions?

Do you feel irritable, angry, or impatient without control of emotions?
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Do you have high blood pressure or cholesterol?

Do you have high blood pressure or cholesterol?
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How did you hear about us?

How did you hear about us?
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I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Men's Questionnaire

Men's Questionnaire

Please rate your symptoms between 0-10, with 0 indicating no symptoms and 10 indicating severe symptoms.

First Name

Last Name

Phone *

Email *

Progesterone Symptoms

Sleep Disturbances

Sleep Disturbances
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Depression

Depression
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List is empty.

Irritability

Irritability
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Anxiety

Anxiety
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Restless Legs Syndrome

Restless Legs Syndrome
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Mood Swings

Mood Swings
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Migraine Headaches

Migraine Headaches
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Palpitations

Palpitations
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Estrogen Symptoms

Night Sweats

Night Sweats
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Hot Flashes

Hot Flashes
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Dry Skin

Dry Skin
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Testosterone Symptoms

Erectile Dysfunction

Erectile Dysfunction
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Fatigue

Fatigue
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Low Sex Drive

Low Sex Drive
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Poor Focus

Poor Focus
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Body & Joint Pain

Body & Joint Pain
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Memory Lapses

Memory Lapses
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Low Exercise Tolerance

Low Exercise Tolerance
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Loss of Muscle Tone

Loss of Muscle Tone
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Acne

Acne
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Hair Loss

Hair Loss
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How did you hear about us?

How did you hear about us?
TV
Online Search
Friend
Dr. Referred
Social Media
Online Ad
Other
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List is empty.

I agree to terms & conditions provided by the company as stated in the privacy policy at www.hhwoc.com. By providing my phone number, I agree to receive text messages from the business.

Address

1190 Bookcliff Avenue, Suite 202Grand Junction, CO 81501

Phone

(970) 812-5115

Monday - Thursday 8:00 am - 6:00 pm

Closed for lunch 12:00 pm - 1:00 pm