Male Assessment Request

  • Please List 1 - 3 Health Goals

  • Symptom Scoring Form

    The following score sheet will help the doctor and you to determine whether hormone testing is needed and which tests to order. Each category is divided into hormone deficiency and excess as each has a different subset of symptoms. Please score the symptoms which apply to you.

    Scoring Scale: 0 (none), 1(mild), 2 (moderate), or 3 (severe). * A cumulative score of 10 (ten) or higher within any single category (deficiency and excess combined) suggests testing may be beneficial.

  • Administrative Scores