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Specialized Therapies:
* Joint Repair
* Hormone Optimization
* Medical Weight Loss
Health History & Symptoms
MALE PATIENTS
First Name
Last Name
Today's Date
Date of birth
Age
Height:
Current Weight
Have you been diagnosed with any cancer since initial pelleting? (excluding basal cell carcinoma)?
YES
NO
No elements found. Consider changing the search query.
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Blood Clot, DVT, heart attack or stroke since initial pelleting and/or last visit?
YES
NO
No elements found. Consider changing the search query.
List is empty.
Any changes in medical conditions since initial pelleting and/or last visit?
Any changes in medications since initial pelleting and/or last visit?
Biote Male Health History + Symptoms (Continuous Maintenance)
Acne
Erectile Dysfunction (ED)
Decreased Libido
Inability to or delayed Orgasm
Weight Gain
Decreased Muscle Mass
Difficulty Sleeping
Urinary Incontinence
Dry or Flaking Skin
Lack of Energy (Fatigue)
Decrease in Strength or Endurance
Decrease in Work Performance
Frequent Urinary Tract Infections
Brittle Nails
Thinning Eyebrows
Hair Thinning
Cold Hands or Feet
Mind Racing at Bedtime
Eating When Stressed
Mood Swings
Gynecomastia
Abdominal Obesity
Verification Statement
The above information is true to the best of my knowledge.
Patient Signature
*
Clear
