bioTE Male Questionnaire - Aurora Medical Spa - St. Louis MO

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Hormone Assessment for Men

Choose which symptoms apply to you currently (in the last 2 weeks):

Your Name

Your Email Address

Your Phone Number

Sweating (night sweats or excessive sweating)

Never Mild Moderate Severe Very Severe

Sleep problems (difficulty falling asleep, sleeping through the night or waking up too early)

Never Mild Moderate Severe Very Severe

Increased need for sleep or falls asleep easily after a meal

Never Mild Moderate Severe Very Severe

Depressive mood (feeling down, sad, lack of drive)

Never Mild Moderate Severe Very Severe

Irritability (mood swings, feel aggressive, angers easily)

Never Mild Moderate Severe Very Severe

Anxiety (inner restlessness, feeling panicky, feeling nervous, inner tension)

Never Mild Moderate Severe Very Severe

Physical exhaustion (general decrease in muscle strength or endurance, decrease in work performance, fatigue, lack of energy, stamina or motivation)

Never Mild Moderate Severe Very Severe

Sexual problems (change in sexual desire or in sexual performance)

Never Mild Moderate Severe Very Severe

Bladder problems (difficulty in urinating, increased need to urinate)

Never Mild Moderate Severe Very Severe

Erectile changes (less strong erections, loss of morning erections)

Never Mild Moderate Severe Very Severe

Joint and muscular symptoms (joint pain swelling, muscle weakness, poor recovery after exercise)

Never Mild Moderate Severe Very Severe

Difficulties with memory

Never Mild Moderate Severe Very Severe

Problems with thinking, concentrating or reasoning

Never Mild Moderate Severe Very Severe

Difficulty learning new things

Never Mild Moderate Severe Very Severe

Trouble thinking of the right word to describe persons, places or things when speaking

Never Mild Moderate Severe Very Severe

Increase in frequency or intensity of headaches/migraines

Never Mild Moderate Severe Very Severe

Rapid hair loss or thinning

Never Mild Moderate Severe Very Severe

Feel cold all the time or have cold hands or feet

Never Mild Moderate Severe Very Severe

Weight gain, increased belly fat, or difficulty losing weight despite diet and exercise

Never Mild Moderate Severe Very Severe

Infrequent or absent ejaculations

Never Mild Moderate Severe Very Severe

Please complete all questions above to receive your score. By completing the assessment, you give Aurora Medical Spa permission to score the results and contact you to provide further information.

CHESTERFIELD VALLEY

Call 314-822-1060

116 Chesterfield Commons E Rd,

Chesterfield, MO 63005

DES PERES

Call 314-822-1060

13319 Manchester Road

Des Peres, MO 63131

CAPE GIRARDEAU

Call 573-271-5120

3117 Lexington Avenue – Suite 103

Cape Girardeau, MO 63701

Georgetown

Call 512-359-8349

1013 West University Ave. Suite 193

Georgetown, TX 78628

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Contact

choose a topic

Injectables & Dermal Fillers

Botox Dermal Fillers Dysport Kybella QWO

CoolSculpting CoolTone Kybella QWO

1540 Skin Renewal B12 Shots Dermaplaning Diamond Glow IPL KeraLase Hair Restoration LaseMD Skin Resurfacing Laser Hair Removal Latisse Eyelash Growth Microdermabrasion Microneedling RF Microneedling

BioTE Identical Hormones

BioTE Hormone Replacement Therapy (BHRT) Female Assessment Male Assessment

Facials & Peels

Hydrafacial Illuminize Peel Rejuvenize Peel Vitalize Peel

Facial Conditions

Acne Brow Volume Clogged Pores Double Chin Dry Skin Fine Lines & Wrinkles Hair Restoration Hair Removal Lip Volume Melasma Rosacea Sagging Skin Sun Spots & Discoloration Unwanted Hair

Body Conditions

Cellulite (Buttocks) Excessive Perspiration Hair Restoration Hair Removal Hand Rejuvenation Muscle Tone Sun Spots & Discoloration TMJ Unwanted Fat Unwanted Hair

Hormone Imbalance

BioTE Hormone Replacement Therapy (BHRT) Female Assessment Male Assessment

Request a Free Consultation
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