Please complete the form below: Step 1 of 3 33% Name* First Last Email* Phone*What is the best way to contact you?* Phone Text Email What is the best time to reach you?*Additional InfoWhat is location is closest to you?*SouthlakeRockwallHow did you hear about us?*CinemarkSearch EngineTVRadioFriend / Family MemberYellow PagesChamber of CommerceFacebookTwitterInstagramAlison ArmstrongPhysician Which of the following symptoms apply at this time? Place check EACH symptom. For symptoms that do not apply, please mark NONE.Decline in your feeling of general well-being (general state of health, subjective feeling)NoneMildModerateSevereExtremely SevereJoint pain and muscular ache (lower back pain, joint pain, pain in a limb, general back ache)NoneMildModerateSevereExtremely SevereExcessive sweating (unexpected/sudden episodes of sweating, hot flushes independent of strain)NoneMildModerateSevereExtremely SevereSleep problems (difficulty in falling asleep difficulty in sleeping through, waking up early and feeling tired, poor sleep, sleeplessness)NoneMildModerateSevereExtremely SevereIncreased need for sleep, often feeling tiredNoneMildModerateSevereExtremely SevereIrritability (feeling aggressive, easily upset about little things, moody)NoneMildModerateSevereExtremely SevereNervousness (inner tension, restlessness, feeling fidgety)NoneMildModerateSevereExtremely SevereAnxiety (feeling panicky)NoneMildModerateSevereExtremely SeverePhysical exhaustion / lacking vitality (general decrease in performance, reduced activity, lacking interest in leisure activities, feeling of getting less done, of achieving less, of having to force oneself to undertake activities)NoneMildModerateSevereExtremely SevereDecrease in muscular strength (feeling of weakness)NoneMildModerateSevereExtremely Severe Which of the following symptoms apply at this time? Place check EACH symptom. For symptoms that do not apply, please mark NONE.Depressive mood (feeling down, sad, on the verge of tears, lack of drive, mood swings, feeling nothing is of any use)NoneMildModerateSevereExtremely SevereFeeling that you have passed your peakNoneMildModerateSevereExtremely SevereFeeling burnt out, having hit rock-bottomNoneMildModerateSevereExtremely SevereDecrease in beard growthNoneMildModerateSevereExtremely SevereDecrease in ability/frequency to perform sexuallyNoneMildModerateSevereExtremely SevereDecrease in the number of morning erectionsNoneMildModerateSevereExtremely SevereDecrease in sexual desire/libido (lacking pleasure in sex, lacking desire for sexual intercourse)NoneMildModerateSevereExtremely SeverePlease share any additional comments about your symptoms you would like to address.Please list any prior hormone therapy?Recent PSA:Recent Digital Rectal Exam (Date)What were the results?NormalAbnormalHistory of Prostate problems or Biopsy. If so, please provide details.