TRT Questionnaire for Women – BodyRejuvenation

How difficult is it for you to build muscle?

Extremely difficult
Very difficult
Moderately difficult
It’s easy for me

How hard is it for you to lose fat?

Feels impossible
Very hard
Moderately hard
It's easy for me

How would you rate your sex drive (libido)? “My sex drive…”

Dropped significantly
Somewhat declined
Feels OK
Is excellent

How would you rate your overall happiness and wellbeing?

Always unhappy
Usually unhappy
Depends on the day
Always happy

Which of these results would make the BIGGEST difference in your life?

When was the last time you got your blood work done?

Within last 30 days
Within last three months
Within last year
Over a year

Are you currently under any form of hormonal treatment?

Yes
No

Please specify

What are your primary health goals?

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

Yes
No

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

Yes
No

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

Yes
No

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

Yes
No

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

Yes
No

How much do you budget for your wellness each year?

Less than $1000
More than $1000. Less than $10,000
More than $10,000

We know this question may feel personal—but it's important. It helps us prioritize patients who are committed to long-term results, and tailor recommendations that make sense financially and medically.

In the last 3–6 months, what’s been the most frustrating part about your health, energy, or appearance? Please be as specific as possible

(numbers on the scale, lab results, clothes that don’t fit, comments from others, photos you didn’t like, etc.).

Can you describe a recent moment when this problem really bothered you or got in the way of your life? What happened, and how did it make you feel?

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.

Please specify

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

Yes
I can make it
No, but I'm OK with a virtual consultation

If you live far, we do offer virtual consultations