ED Questionnaire – BodyRejuvenation

Have you been formally diagnosed with Erectile Dysfunction by a healthcare provider?

How long have you been experiencing symptoms of ED?

Have you noticed any improvement in your symptoms with your current treatment?

Briefly describe if you experienced any side effects from your current ED medication?

Have you previously tried any of the following treatments for ED? (Check all that apply)

Do you smoke or use tobacco products?

Are you interested in proactive healthcare and preventative measures to optimize your health and longevity?

Do you stay active and prioritize healthy lifestyle habits like exercise and nutrition?

Would you be open to exploring evidence-based, cutting-edge therapies for anti-aging and wellness?

Are you comfortable providing recent blood work or participating in a comprehensive health assessment?

Do you believe in a collaborative approach to healthcare, working with medical professionals to achieve your goals?

Enter your zip code

We need to make sure your state allows telehealth.

Name

First

Last

Email

Phone

How did you hear about us?

Please specify

If you heard about us from another source, please specify.

Our clinic is located in Hallandale, Florida, are you nearby?