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Birthday
Month
Day
Year
Height
General Health
Medical/Social History (Check all that apply)
Do you feel more fatigued and/or tired than usual?
Have you noticed a decrease in your muscle mass?
Have you experienced a loss in muscle strength?
Have you noticed an increase in joint and/or muscle pain?
Have you noticed an increase in your waist size?
Do you have trouble losing weight?
Have you experienced a loss in height?
Have you experienced a decrease in your sex drive?
Have you experienced difficulty in establishing and/or maintaining full erections?
Have you experienced changes in your usual sleep patterns?
Have you noticed a decrease in mental sharpness?
Have you had trouble concentrating?
Do you experience less enjoyment in personal interests and hobbies?
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