TestoThera Testosterone Clinic

Testosterone (TRT)
Weight Loss
- Semaglutide
Extra Services
Locations
About Us
- Job Openings
- Blog
FAQ

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Testosterone (TRT)
Weight Loss
- Semaglutide
Extra Services
Locations
About Us
- Job Openings
- Blog
FAQ

Schedule Appointment

Weight Loss Support Survey

Fill out our questionnaire

Name(Required)

First Last

Age(Required)

Phone Number(Required)

Email(Required)

Current weight(Required)

Desired weight(Required)

Have you tried prescription weight loss medications in the past(Required)

Yes

No

list the medication have you taken already

how much dose have take ? type the names here..

Date they last took it

MM slash DD slash YYYY

Time spent on medication

Hours

:

Minutes

AM/PM

Have you attempted any special diet routines?(Required)

Yes

No

Did you lose weight from this diet?(Required)

yes

no

How much weight did you lose from this diet?(Required)

1-5kg

5-10kg

more than 10kg

Elaborate Your weight loss diet list…(Required)

How much period have you taken the diet plan(in days)?(Required)

Do you have any dietary restrictions?(Required)

Yes

No

List your dietary restrictions…(Required)

Do you have any other medical conditions?(Required)

Yes

No

Elaborate your medical restrictions….(Required)

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Take the Test.

Simple steps help solve Low T.

veteran owned business

Clinical Laboratory Accreditation

346-202-6671
corporate@TestoThera.com
6445 FM 1463 Ste 140 Katy, TX 77494
(fax) 346-202-6676

© 2024 | TestoThera Low T Center | All Rights Reserved | BWG

Do you have low energy levels or find your self fatigued at the end of the day?

Yes

No

Do you notice less muscle and more belly fat?

Yes

No

Difficulty with mental focus, memory, or mental sharpness?

Yes

No

Do you notice Anxiety, moodiness, depression, or feeling “in a funk”?

Yes

No

Difficulty getting or maintain an erection?

Yes

No

Decreased libido (lack of desire for sex)?

Yes

No

Are you working out and not seeing any results?

Yes

No

Looks like you might have a problem with low testosterone that one of our specialists could help with.

Schedule New Patient Appointment
Schedule Existing Patient Appointment

OR

Send in details and we'll contact you to schedule an appointment.

Name(Required)

First Last

Age (years)(Required)

Current Weight (lbs)

Desired Weight (lbs)

Phone

Email(Required)

Δ

Feedback(Required)

Δ

Sex

Male

Female

Are you experiencing poor erection quality?(Required)

Do you notice that you quickly lose your erections?(Required)

Do you avoid intimacy in the bedroom because you are worried you won't be able to perform?(Required)

Do you have difficulty ejaculating / climaxing?(Required)

Do you worry about your sexual performance?(Required)

When fully erect does your penis drastically curve instead of remaining erect?(Required)

How often to do you think about sex? Rarely, sometimes, more often than not, all the time?(Required)

Do you notice painful intercourse?(Required)

Do you noticed that you "are not in the mood" more often than before?(Required)

Do you notice vaginal dryness that makes intercourse difficult?(Required)

Do you have difficulty ejaculating/ climaxing?(Required)

How often to do you think about sex? Rarely, sometimes, more often than not, all the time?(Required)

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Name(Required)

First Last

DOB

MM slash DD slash YYYY

Phone Number

Email(Required)

I am interested in these vitamins:(Required)

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