770.649.0094
4343 Shallowford Rd, Ste 150,Marietta, GA 30062
VIRTUAL CONSULTATION
TEXT US
Home Page
About Us
Pricing
WellnesslVibrant Aging
Weight Loss
Semaglutide
IV Therapy
Oshot l Feminine Rejuv
O Shot
Vampire winglift
V fit Gold
Procedures
Xeomin Wrinkle relaxer
Botox
Wrinkle Fillers- Contour and Rejuvenate
Hyperdilute Radiesse
Vampire Facial(tm) -Microneedling with PRP
Exilis Elite Facial Skin Tightening
PRP Hair Therapy
Pre and Post PRP hair Instructions
PRP Injections
O Shot
Testimonials
Book
770.649.0094
4343 Shallowford Rd, Ste 150,Marietta, GA 30062
VIRTUAL CONSULTATION
TEXT US
Home Page
About Us
Pricing
WellnesslVibrant Aging
Weight Loss
Semaglutide
IV Therapy
Oshot l Feminine Rejuv
O Shot
Vampire winglift
V fit Gold
Procedures
Xeomin Wrinkle relaxer
Botox
Wrinkle Fillers- Contour and Rejuvenate
Hyperdilute Radiesse
Vampire Facial(tm) -Microneedling with PRP
Exilis Elite Facial Skin Tightening
PRP Hair Therapy
Pre and Post PRP hair Instructions
PRP Injections
O Shot
Testimonials
Book
Home Page
About Us
Pricing
WellnesslVibrant Aging
Weight Loss
Semaglutide
IV Therapy
Oshot l Feminine Rejuv
O Shot
Vampire winglift
V fit Gold
Procedures
Xeomin Wrinkle relaxer
Botox
Wrinkle Fillers- Contour and Rejuvenate
Hyperdilute Radiesse
Vampire Facial(tm) -Microneedling with PRP
Exilis Elite Facial Skin Tightening
PRP Hair Therapy
Pre and Post PRP hair Instructions
PRP Injections
O Shot
Testimonials
Book
Hormone/Wellness Male Follow Up Form
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Hormone/Wellness Male Follow Up Form
General Information
Name:
Email address. We will email you a copy of your results before your appt
What is the best number for us to reach you for this follow up?
How are you doing overall?
Is their something you would like to improve?
If yes, please describe
Are you taking your hormone meds as they have been prescribed?
Yes
No
If not, how are you taking your hormones?
Please tell us about any other medications (besides hormones) that you are taking.
Please list the supplements you are taking
Health Screening Questions
When was your last prostate exam?
Last PSA
Last Colonoscopy:
Do you have a Primary Care doctor?
Have you had lab testing with your PCP?
Yes
No
Signs of testosterone imbalance
Checkbox
Fatigue
Difficulty building muscle
Low libido
Sexual dysfunction
Quick to anger
Family members saying your are irritable
Signs of thyroid imbalance
Please check if you are experiencing
palpitations
increased heart rate
agitation
fatigue
feeling cold
dry skin
constipation
brain fog/difficulty focusing
Signs of low growth hormone
Please check off symptoms you are experiencing
Poor sleep
Low energy
Not as motivated
Difficulty building exercise
Desire to take naps
Low desire to exercise
Increased body fat
Less stamina
Anxiety
We are developing a Body Composition program. Maintenance of lean muscle is important for overall health, longevity and vitality. Would you be interested in learning more?
Yes
No
