Hormone Imbalance Self-Assessment Thank you for completing the HRT Candidacy Quiz. Based on your results, it appears that you are a candidate for the Hormone Replacement Therapy program. We understand that you may be experiencing more symptoms than the ones just listed, and we plan to address all of your symptoms and concerns. In order to best serve you, we need to review your medical history. Click HERE to complete and submit your initial hormone therapy consultation form. Once our providers have reviewed your medical history and determined whether you may be eligible, we will contact you to schedule an initial blood draw. Are You a Candidate for Hormone Replacement Therapy? Are you struggling with a lack of energy or motivation?YesNo Lacking or experiencing a decline in libido?YesNo Do you have trouble going to sleep or getting a good night's sleep?YesNo Is it common for you to experience mood swings or irritability?YesNo Men: Are you affected by night sweats or erectile dysfunction?YesNoN/A Women: Are you experiencing hot flashes and/or vaginal dryness?YesNoN/A Have you experienced unexplained weight gain and/or struggling to lose weight?YesNo Name* First * Last Email* By providing your email, you will be subscribed to our bi-weekly newsletter with health and beauty tips, delicious recipes, fresh links, and more. You can unsubscribe at any time. What are you interested in?Hormone Replacement Therapy (HRT)Joint & Tendon PRPSexual MedicineMedSpaWeight Loss
