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Please fill out the following below
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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 currently have or have previously experienced any of the following?
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Are you currently experiencing any of the following or have previously experienced 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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Are you allergic to any over the counter or prescription medications?
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Are you currently on any medications? (please list all medications, reason for medication, and dosage)
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