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How did you hear about us?
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Individual that referred you?
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What are your goals?
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What service(s) are you most interested in?
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Do you have any of the following?
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Are you experiencing any of the following?
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Have you used testosterone/anabolics before?
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If yes how much and how long?
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Please select all symptoms that apply
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Constitutional
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Eyes
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Ear/Nose/Throat
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Respiratory
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Cardiovascular
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Gastrointestinal
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Neurological
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Musculoskeletal
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Skin
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Psychiatric
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Genitourinary
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Endocrine
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Chest
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Respiratory
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