Complete the Androgen Deficiency (Low Testosterone) Assessment Questionnaire

Androgen Deficiency in Aging Males (ADAM) Questionnaire:

Please note that all fields followed by an asterisk must be filled in.
First Name*
Last Name*
E-Mail Address*
Home Phone
1) Do you have a decrease in libido or sex drive?
Yes
No
2) Do you have a lack of energy?
Yes
No
3) Do you have a decrease in strength or endurance?
Yes
No
4) Have you lost weight?
Yes
No
5) Have you noticed a decrease in enjoyment of life?
Yes
No
6) Are you sad or grumpy?
Yes
No
7) Are your erections less strong?
Yes
No
8) Do you frequently fall asleep after dinner?
Yes
No
9) Have you noticed a recent deterioration in your ability to play sports?
Yes
No
10) Has there been a recent deterioration in your work performance?
Yes
No

Please enter the word that you see below.

  

When you complete the Androgen Deficiency (Low Testosterone) in Aging Males (ADAM) Questionnaire and click "submit", a few things will happen.

First, you will be directed to the results page for information on what your score means.

Secondly, a copy of your questionnaire will be sent to Phoenix Wellness Clinic for review. One of our team members will contact you via e-mail or phone within 24 hours.

Rest assured, your results are confidential! Maintaining your privacy is of utmost importance to us.