This subjective questionnaire will give your health care practitioner a quick summary of symptoms or signs that may be related to common men's health issues. It is not a substitute for professional medical advice from your health care provider. Do you have a lack of energy?*YesNoDo you have a decrease in your strength and/or endurance? *YesNoAre you less active in social activities and/or sports? *YesNoDo you feel you're performing less at work? *YesNoAre you sleeping too much or too little? *YesNoDo you feel sad and/or grumpy?*YesNoAre you forgetful?*YesNoDo you live a stressful lifestyle? *YesNoHave you noticed a decrease in your sex drive?*YesNoDo you frequently get up at night to urinate?*YesNoDo you experience any discomfort when urinating?*YesNoAre you overweight?*YesNoHave you lost height?*YesNoName* First Last Phone*Email*