678-335-4849
678-335-4849
HOME
ABOUT
Our Team
Blog
Patient Forms
Patient Intake Form
Female Hormone Deficiency Questionnaire
ADAM Questionnaire
Our Clients
Athletes
Testimonials
MEN
Testosterone Therapy
Medical Weight Loss
Men’s Sexual Health
HGH And IFG-1 Therapy
IV Therapy
Nutraceuticals
Stem Cell Therapy
Acoustic Wave Therapy
Acoustic Lipo Sculpting
Dermal Fillers
Dermaplaning
Dysport Wrinkle Reducer
Facials
Facial Peels
IPL Photofacial
KYBELLA
Laser Treatments
Microneedling
Skin Tightening
WOMEN
Bio-Identical Hormone Replacement Therapy
Medical Weight Loss
Women’s Sexual Wellness
Women’s Libido Services
Vaginal Rejuvenation
IV Therapy
Nutraceuticals
Stem Cell Therapy
Acoustic Lipo Sculpting
Dermal Fillers
Dermaplaning
Dysport Wrinkle Reducer
Facial Treatments
Facial Peels
IPL Photofacial
KYBELLA
Laser Treatments
Microneedling
Skin Tightening
SPECIALS
LOCATIONS
Norcross
Roswell
Boston
Remote Appointments
ORDER MEDICATION
BLOG
CONTACT
Menu
HOME
ABOUT
Our Team
Blog
Patient Forms
Patient Intake Form
Female Hormone Deficiency Questionnaire
ADAM Questionnaire
Our Clients
Athletes
Testimonials
MEN
Testosterone Therapy
Medical Weight Loss
Men’s Sexual Health
HGH And IFG-1 Therapy
IV Therapy
Nutraceuticals
Stem Cell Therapy
Acoustic Wave Therapy
Acoustic Lipo Sculpting
Dermal Fillers
Dermaplaning
Dysport Wrinkle Reducer
Facials
Facial Peels
IPL Photofacial
KYBELLA
Laser Treatments
Microneedling
Skin Tightening
WOMEN
Bio-Identical Hormone Replacement Therapy
Medical Weight Loss
Women’s Sexual Wellness
Women’s Libido Services
Vaginal Rejuvenation
IV Therapy
Nutraceuticals
Stem Cell Therapy
Acoustic Lipo Sculpting
Dermal Fillers
Dermaplaning
Dysport Wrinkle Reducer
Facial Treatments
Facial Peels
IPL Photofacial
KYBELLA
Laser Treatments
Microneedling
Skin Tightening
SPECIALS
LOCATIONS
Norcross
Roswell
Boston
Remote Appointments
ORDER MEDICATION
BLOG
CONTACT
HOME
ABOUT
Our Team
Blog
Patient Forms
Patient Intake Form
Female Hormone Deficiency Questionnaire
ADAM Questionnaire
Our Clients
Athletes
Testimonials
MEN
Testosterone Therapy
Medical Weight Loss
Men’s Sexual Health
HGH And IFG-1 Therapy
IV Therapy
Nutraceuticals
Stem Cell Therapy
Acoustic Wave Therapy
Acoustic Lipo Sculpting
Dermal Fillers
Dermaplaning
Dysport Wrinkle Reducer
Facials
Facial Peels
IPL Photofacial
KYBELLA
Laser Treatments
Microneedling
Skin Tightening
WOMEN
Bio-Identical Hormone Replacement Therapy
Medical Weight Loss
Women’s Sexual Wellness
Women’s Libido Services
Vaginal Rejuvenation
IV Therapy
Nutraceuticals
Stem Cell Therapy
Acoustic Lipo Sculpting
Dermal Fillers
Dermaplaning
Dysport Wrinkle Reducer
Facial Treatments
Facial Peels
IPL Photofacial
KYBELLA
Laser Treatments
Microneedling
Skin Tightening
SPECIALS
LOCATIONS
Norcross
Roswell
Boston
Remote Appointments
ORDER MEDICATION
BLOG
CONTACT
Menu
HOME
ABOUT
Our Team
Blog
Patient Forms
Patient Intake Form
Female Hormone Deficiency Questionnaire
ADAM Questionnaire
Our Clients
Athletes
Testimonials
MEN
Testosterone Therapy
Medical Weight Loss
Men’s Sexual Health
HGH And IFG-1 Therapy
IV Therapy
Nutraceuticals
Stem Cell Therapy
Acoustic Wave Therapy
Acoustic Lipo Sculpting
Dermal Fillers
Dermaplaning
Dysport Wrinkle Reducer
Facials
Facial Peels
IPL Photofacial
KYBELLA
Laser Treatments
Microneedling
Skin Tightening
WOMEN
Bio-Identical Hormone Replacement Therapy
Medical Weight Loss
Women’s Sexual Wellness
Women’s Libido Services
Vaginal Rejuvenation
IV Therapy
Nutraceuticals
Stem Cell Therapy
Acoustic Lipo Sculpting
Dermal Fillers
Dermaplaning
Dysport Wrinkle Reducer
Facial Treatments
Facial Peels
IPL Photofacial
KYBELLA
Laser Treatments
Microneedling
Skin Tightening
SPECIALS
LOCATIONS
Norcross
Roswell
Boston
Remote Appointments
ORDER MEDICATION
BLOG
CONTACT
FEEL
BETTER
LOOK
BETTER
PERFORM
BETTER
WE CHANGE LIVES
EVERY DAY
SCHEDULE AN APPOINTMENT
GET STARTED
Fill out online or download & print to fill out offline.
DOWNLOAD FORM
FEMALE HORMONE
DEFICIENCY QUESTIONNAIRE
Name
First
Last
Email
Phone
Age
Weight
Height
Please answer each of the questions below by choosing 'Yes' or 'No'.
Do you have difficulty waking up in the mornings?
Yes
No
Do you always feel tired or exhausted?
Yes
No
Do you sleep poorly?
Yes
No
Are you frequently anxious, nervous or irritable?
Yes
No
Do you suffer from short- or long-term memory loss?
Yes
No
Do you have trouble concentrating?
Yes
No
Do you lack sexual desire?
Yes
No
Have you lost your attraction toward your partner?
Yes
No
Are you currently experiencing vaginal dryness?
Yes
No
Have you recently gained weight or do you have difficulty losing weight?
Yes
No
Do you carry your weight in your mid-section?
Yes
No
Have you lost muscle mass, tone and/or strength?
Yes
No
Select A Location
*
Select A Location
Roswell
Sandy Springs/Atlanta
Peachtree Corners
Boston
CAPTCHA
English
English
Portuguese
Need to re-order
medication
Please enable JavaScript in your browser to complete this form.
Name
*
Email
*
Phone
Location
*
Select Your Location
Roswell
Sandy Springs/Atlanta
Peachtree Corners
Boston
Medication I Need
Submit
Need to re-order
medication
Please enable JavaScript in your browser to complete this form.
Name
*
Email
*
Phone
*
Medication I Need
*
Submit
English
Portuguese