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AESTHETICS
EVEXIPEL HORMONE THERAPY
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- Hormone Optimization For Women
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AESTHETICS
EVEXIPEL HORMONE THERAPY
- Hormone Optimization For Men
- Hormone Optimization For Women
REGENERATIVE THERAPIES
ABOUT
BLOG
SHOP
- EVEXIAS Products
- Metagenics Products
CONTACT
- New Patient Paperwork

Male Symptom Checklist

EVEXIAS Medical Centers - The Experts in Hair Loss Solutions in Southlake Texas for Men and Women

Name *

First

Last

Email Address *

Phone

EMC Location *

FATIGUE *

NEVER
MILD
MODERATE
SEVERE

HAIR LOSS *

NEVER
MILD
MODERATE
SEVERE

COLD HANDS & FEET *

NEVER
MILD
MODERATE
SEVERE

DECREASED MENTAL ABILITY *

NEVER
MILD
MODERATE
SEVERE

SLEEP PROBLEMS *

NEVER
MILD
MODERATE
SEVERE

INABILITY TO MAINTAIN ERECTIONS *

NEVER
MILD
MODERATE
SEVERE

MOOD CHANGES *

NEVER
MILD
MODERATE
SEVERE

WEIGHT GAIN *

NEVER
MILD
MODERATE
SEVERE

EXCESSIVE SWEATING *

NEVER
MILD
MODERATE
SEVERE

DECREASED SEX DRIVE *

NEVER
MILD
MODERATE
SEVERE

Message *

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