Male Hormone Wellness Quiz

Complete our Male Hormone Wellness Quiz to get a better understanding of whether you are a good candidate for hormone pellet therapy. If you would like for Duke City Health to reach out to you about your treatment options, please provide us with your contact information in the fields at the end of this form.

We take your privacy seriously. The information submitted through this form will only be shared with the staff at Duke City Health.

MALE HORMONE PELLET THERAPY FAQ

Your Contact Info

Gender

  • - Please Select -
  • MALE
  • FEMALE

Symptoms

Please select a gender to show symptoms
FATIGUE
MOOD CHANGES
DECREASED MENTAL ABILITY
EXCESSIVE SWEATING
HOT FLASHES / NIGHT SWEATS
WEIGHT GAIN
DECREASED SEX DRIVE
SLEEP PROBLEMS
COLD HANDS & FEET
DECREASED MUSCLE STRENGTH
HAIR LOSS
HAIR LOSS & BREAKAGE
DRY, ITCHY SKIN
JOINT PAIN

Family History

Please select a gender to show family history questions
Check All That Apply
Check All That Apply
Kristi Fury CFNP Family Medicine Nurse Practitioner Specializing in Hormone Therapy and Regenerative Medicine in Albuquerque, New Mexico 87120