Birthday

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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?