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Testosterone
Testosterone
Step
1
of
26
3%
First, tell us what you are looking to accomplish?
(Required)
Gain Muscle Mass
Lose body fat
Sleep better
Increase Energy
Increase Libido
Something else
Explain what other goals they want to accomplish with testosterone.
(Required)
What is your name by the way?
(Required)
Marry, welcome to Satori MD. Let’s learn a little bit more about you and determine your testosterone levels now.
(Required)
What is your birthdate?
(Required)
MM slash DD slash YYYY
What is your birth gender?
(Required)
Male
Female
Other
How tall are you?
(Required)
How much do you weight?
(Required)
⦁ 70%-90% of men on Testosterone Replacement Therapy see an improvement in
Email
(Required)
Phone Number
Depending on what age they give us will determine what is shown.
(Required)
Below Age 25: 692
25-29: 669
30-34: 621
35-39: 597
40-44: 546
50-54: 544
55-59: 552
60-74: 524
75+: 471
Do you know your total testosterone count currently?
(Required)
Yes
No
what is the total testosterone count?
(Required)
Date of last total testosterone results.
(Required)
MM slash DD slash YYYY
Thank you for sharing this information. I am willing to bet you could benefit from TRT, let’s get a little bit more information to make sure you qualify. To see if you qualify for testosterone replacement therapy, click Continue
Don’t worry, we will get you instructions of how to find out fairly easily in just a second. Let’s get a little bit more information first to make sure you qualify. To see if you qualify for testosterone replacement therapy, click Continue
Have you seen your primary care provider within the last 24 months?
(Required)
Yes
No
• You should be seeing a primary care provider for yearly checkups. • Satori MD does not provide primary care services. • By continuing, you agree to be evaluated yearly or when recommended by your primary care provider.
Having low testosterone can also be damaging to your mental health. Have you experiencing or been diagnosed with any of these mental health conditions?"
(Required)
None
Anxiety
Depression
PTSD
Panic Attack
Bipolar
Other
mental health condition not listed.
(Required)
We are doing this as soon we will be selling these medications
(Required)
None
Adderall
Wellbutrin
Lexapro
Celexa
Zoloft
Cymbalta
Prozac
Lithium
Other
what mental health medication they are taking.
(Required)
Tell us a little bit about your heart or heart related conditions you may have experienced.
(Required)
High Blood Pressure
Hypertension
High Cholesterol
High Triglycerides
Heart Failure
Heart Attack
Heart Rhythm Issues or ECG abnormalities
Atrial fibrillation or flutter
Heart disease or stroke
Rapid Heart Rate
None
Have you had a blood pressure test in the last 18 months?
(Required)
Yes
No
Have you ever been diagnosed with a hormone, kidney, or liver condition?
(Required)
Enlarged Prostate
Frequent Urining
Painful Urine
Poor flowing Urine
Kidney Stones
Graves Disease
Chronic Kidney Disease
Thyroid Cancer
Family History of Thyroid Cancer
Hypothyroidism
Hyperthyroidism
Fatty Liver Disease
Multiple Endocrine Neoplasia Syndrome type 2
SIADH
Other Thyroid Issue
No, I haven’t been diagnosed with any of these conditions.
Do you have any of these health conditions?
(Required)
Diabetes
Prediabetes
Pancreatitis
Delayed Gastric Emptying
Gallbladder disease or Gallstones
Acid Reflux
Bariatric Surgery
No, I haven’t been diagnosed with any of these conditions.
Please tell us more about your lifestyle
(Required)
Strongly Agree
Agree
Neither Agree or Disagree
Disagree
Strongly Agree
Having low testosterone has reduced the energy I have to perform routine activities.
Having low testosterone has noticeably reduced the amount of muscle mass on my body.
(Required)
Strongly Agree
Agree
Neither Agree or Disagree
Disagree
Strongly Agree
Having low testosterone has caused me to gain access weight around my waist.
(Required)
Strongly Agree
Agree
Neither Agree or Disagree
Disagree
Strongly Agree
Having low testosterone has caused me have unrestful sleep at night.
(Required)
Strongly Agree
Agree
Neither Agree or Disagree
Disagree
Strongly Agree
Having low testosterone has caused me to have a lower libido.
(Required)
Strongly Agree
Agree
Neither Agree or Disagree
Disagree
Strongly Agree
Are you allergic to any medicine, food, or supplements? List any that you have:
(Required)
What is your experience with testosterone replacement therapy?
(Required)
I have tried in the past
I am currently using
I have never tried before
Is having children in the future important to you?
(Required)
Yes
No
There is additional medication you should take that can protect your ability to produce sperm while taking testosterone replacement. Your doctor will go over this during your exam.
(Required)
Aside from losing weight, are there any other areas of your health you would like to improve?
(Required)
Hair regrowth
Better Sex
Weight Loss
Mental Health Therapy
Mental health medication
Sleep
Pain
None of these
Is there anything else you would want to share with your Testosterone health care provider?
(Required)
Yes
No
please describe below.
(Required)
This should be much more prominent. The entire purpose of filling out this quiz is for the results of the next page.
Congrats! Based on the answers you have given us; we think you are a good candidate for testosterone replacement therapy. Click here to see what products are available for you.