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Why Are You Seeing Us Today?
Testosterone Replacement
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Have You Had Any Of The Following Conditions?
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ERECTILE DYSFUNCTION
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GENETIC/INHERITED
Has Any Member Of Your Family Had Any Of The Following Conditions?
HIGH CHOLESTEROL
HEART DISEASE/ ATTACK
HIGH BLOOD PRESSURE
STROKE
BLOOD CLOTS
BREAST CANCER
DIABETES
THYROID PROBLEMS
LIVER DISEASE
CERVICAL CANCER
ENDOMETRIOSIS
HIV/AIDS
KIDNEY/ BLADDER PROBLEMS
ANEMIA
BLOOD TRANSFUSION
BLEEDING DISORDER
PROSTATE DISEASE
PROSTATE CANCER
ERECTILE DYSFUNCTION
COLON CANCER
GENETIC/INHERITED
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Current Prescription Medications
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