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PERSONAL SELF EVALUATION

Right now, it's very likely your hormone levels are low. Take this simple quiz to help you decide if you are a candidate for hormonal replacement therapy.

*Name:
Age:
Weight: Height:
Gender:
Male Female
*Phone:
Best time to call:
*Email:
Address:
City:
zip:
Stress
Low Mild High
Nutrition
Poor Balanced Excellent
Activity level :
Passive Moderate Frequent
Do you have a decrease in libido (sex drive)?
Yes No
Do you have a lack of energy and motivation?
Yes No
Do you have a decrease in strength?
Yes No
Do you have a decrease in endurance?

Yes No
Increased body fat, weight gain?
Yes No
Are you losing your figure and muscle tone?
Yes No
Have you noticed a decrease in enjoyment of life?
Yes No
Depression, anxiety or social isolation?
Yes No
Are you often tired and irritable?
Yes No
Do you find yourself forgetting things?
Yes No
Do you have elevated cholesterol levels?

Yes No
 
Comments:
Advance HRT Benefits

Appearance
Muscle Definition
Increased Energy
Endurance
Skin Tone
Reduces Body Fat
Cholesterol Levels
Blood Pressure
Diminishes Wrinkles
Eliminates Cellulite
Kidney function
Bone Density
Stress Levels

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Advance Therapy - Provides hormone replacement therapy information, services and products. Medical consultation and US physician specialist referral, for adult hormone deficiency related symptoms. we also provide diet, fitness, news and nutritional information.

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