Male Health Questionnaire

Welcome
Shop
Laser Studio
Services
Gallery
- Liposuction Gallery
- Brazilian Butt Lift Gallery
BHRT
- Women’s Bioidentical Hormone Replacement Therapy
  - Female Health Questionnaire
  - Female Hormone Balance Quiz
- Men’s Biodentical Hormone Replacement Therapy
  - Male Health Questionnaire
  - Male Hormone Balance Quiz
Hair Loss
Specials
Reviews
Book
Articles
Contact
- Customer Experience Survey

Welcome
Shop
Laser Studio
Services
Gallery
- Liposuction Gallery
- Brazilian Butt Lift Gallery
BHRT
- Women’s Bioidentical Hormone Replacement Therapy
  - Female Health Questionnaire
  - Female Hormone Balance Quiz
- Men’s Biodentical Hormone Replacement Therapy
  - Male Health Questionnaire
  - Male Hormone Balance Quiz
Hair Loss
Specials
Reviews
Book
Articles
Contact
- Customer Experience Survey

Name*
First Last
Email*
Phone
Have you experienced any of the following symptoms recently? Please select the number that best describes your experiences with one being extremely mild and ten being extremely severe.
Decrease in libido (sex drive)?
Erections less strong?
Lack of energy?
Decrease in strength and/or endurance?
Decrease in "enjoyment in life"?
Sad and/or grumpy?
Noted a recent deterioration in your ability to play sports?
Falling asleep after dinner?
Recent deterioration in your work performance?
Other
CAN WE CONTACT YOU?*
- Yes
- No
Current Patient
- Yes
- No

Aesthetic Body Sculpture Clinic - Atlanta/Buckhead
Chastain Oaks
4840 Roswell Road, Bldg D, Suite 100, Sandy Springs, GA 30342

Aesthetic Body Sculpture Clinic - Warner Robins
400 Corporate Pointe, Warner Robins, GA 31088
Email: drslaterclinic@gmail.com

*Disclaimer: This site and its content have been published for informational and advertising purposes only. Results are not guaranteed and vary from patient to patient.

Medical Financing

Care Credit

Gift Certifcates are accepted for all services and products. Gift Cards are not redeemable for cash.

CONTACT US: (770) 691-0570