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(504) 267-4549

info@chronosbhw.com

Home
Aesthetics
Wellness
Fitness Center
Specials
Patient Support
Contact Us

MALE HRT QUIZ

Find out if you are a candidate for Male Hormone Replacement Therapy at Chronos:

Male HRT Quiz

First Name:

Last Name

Email:

Phone:

Address

Are you experiencing fatigue?

Never

Mild

Moderate

Severe

Joint Pain or Muscle Aches?

Never

Mild

Moderate

Severe

Difficulty sleeping or staying sleep?

Never

Mild

Moderate

Severe

Irritability / Anxious / Nervousness?

Never

Mild

Moderate

Severe

Decreased Muscle Strength?

Never

Mild

Moderate

Severe

Weight Gain / Belly Fat / Inability To Lose Weight?

Never

Mild

Moderate

Severe

Decreased Desire / Libido?

Never

Mild

Moderate

Severe

Decreased Morning Erections?

Never

Mild

Moderate

Severe

Depressed Mood?

Never

Mild

Moderate

Severe

Declining Mental Ability/ Focus/ Concentration?

Never

Mild

Moderate

Severe

Are you 40 or older?

Yes

No

Osteoporosis Family History

Yes

No

Alzheimer's Disease Family History

Yes

No

Heart Disease Family History

Yes

No

Diabetes Family History

Yes

No

Thank you for choosing Chronos to support your wellness. We will review your quiz results and a team member will contact you with next steps shortly.

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Please try again later.

LegitScript approved

Home
Aesthetics
Wellness
Fitness Center
Specials
Contact Us

Chronos Body Health & Wellness

info@chronosbhw.com

3200 N. Arnoult Rd. Metairie, LA 70002

Smooth Esthetics

4750 Bluebonnet Blvd, Suite A
Baton Rouge, LA 70809

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