Step 1 of 12 0% Let's Get Started!! Take our FREE health survey and discover potential issues preventing you from reaching your health goals. Based on your answers, we present possible medical, lifestyle, environmental and body chemistry issues hindering your progress. Also, we recommend assessments designed to dig deeper and develop a plan to reach your goals.Full Name* First Name Last Name Email* Phone*Please Select The Closest City To You*Select a CityLouisville, KY Area (Includes Southern Indiana)Lexington, KY AreaCincinnati, OH Area (Includes Northern Kentucky)OtherYour City*Next, tell us your gender.*FemaleMaleAnd now, enter your birth date:*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920By clicking next, you confirming that your birth date is accurate & agree to survey disclosure. Ok, great. Let's get into your medical history.First, tell us about your blood pressure.Have you been told your blood pressure is greater than 120/80?*YesNoDo you take medications to control blood pressure?*YesNoHave you been told you are pre-diabetic or diabetic?*YesNoDo you take medications to control diabetes?*YesNoHave you ever had a panic attack?*YesNoDo you take medications for depression?*YesNo Next, tell us your goals.Please rate the importance of addressing these goals for your health today.Lose Weight/Improve Body Image, Composition*Very ImportantImportantModerately ImportantOf Little ImportanceNot ImportantIncrease Energy, Improve Metabolism*Very ImportantImportantModerately ImportantOf Little ImportanceNot ImportantImprove Sex Drive, Sexual Performance, Sexual FunctionVery ImportantImportantModerately ImportantOf Little ImportanceNot ImportantSleep Better, Wake up Rested*Very ImportantImportantModerately ImportantOf Little ImportanceNot ImportantImprove Mental Clarity & Memory*Very ImportantImportantModerately ImportantOf Little ImportanceNot ImportantImprove Mood, Positive Outlook, Decrease Anxiety*Very ImportantImportantModerately ImportantOf Little ImportanceNot ImportantPrevent-Delay Future Disease*Very ImportantImportantModerately ImportantOf Little ImportanceNot ImportantEliminate Hot Flashes, Night Sweat or Other Age Related Symptoms*Very ImportantImportantModerately ImportantOf Little ImportanceNot ImportantFeel, Look Younger*Very ImportantImportantModerately ImportantOf Little ImportanceNot Important Tell us what's going on, what symptoms do you face?To the best of your ability, please answer the questions below:Physical IssuesMy feet are too hot at night.*NeverSometimesRegularlyOftenConstantlyMy hands and feet are always cold.*NeverSometimesRegularlyOftenConstantlyI have hot flashes and sweats.*NeverSometimesRegularlyOftenConstantlyI'm sensitive to cold.*NeverSometimesRegularlyOftenConstantlyMy joints hurt (fingers, wrists, elbows, feet, ankles, knees).*NeverSometimesRegularlyOftenConstantlyMy joints are stiff.*NeverSometimesRegularlyOftenConstantlyI am constipated.*NeverSometimesRegularlyOftenConstantlyI crave salty.*NeverSometimesRegularlyOftenConstantlyI have abundant, light-colored urine during the day.*NeverSometimesRegularlyOftenConstantlyI have low blood pressure.*NeverSometimesRegularlyOftenConstantly Physical AppearanceMy face has become slack and more wrinkled.*NeverSometimesRegularlyOftenConstantlyMy cheeks sag.*NeverSometimesRegularlyOftenConstantlyMy hair is thinning.*NeverSometimesRegularlyOftenConstantlyMy gums are receding.*NeverSometimesRegularlyOftenConstantlyMy hair is dry.*NeverSometimesRegularlyOftenConstantlyMy skin and eyes are dry.*NeverSometimesRegularlyOftenConstantlyMy skin is thin and/or dry.*NeverSometimesRegularlyOftenConstantlyI look older than I am.*NeverSometimesRegularlyOftenConstantlyI have dry skin.*NeverSometimesRegularlyOftenConstantlyIn the morning, my face is puffy and my eyelids are swollen.*NeverSometimesRegularlyOftenConstantlyI'm losing hair under my arms or in my pubic area.*NeverSometimesRegularlyOftenConstantlyI am losing hair on top of my head.*NeverSometimesRegularlyOftenConstantlyI'm getting thin, vertical wrinkles above my lips.*NeverSometimesRegularlyOftenConstantlyMy eyes are dry and easily irritated.*NeverSometimesRegularlyOftenConstantlyMy face is too hairy.*NeverSometimesRegularlyOftenConstantly Exercise and StaminaI tire easily with physical activity.*NeverSometimesRegularlyOftenConstantlyI am constantly tired.*NeverSometimesRegularlyOftenConstantlyI feel exhausted.*NeverSometimesRegularlyOftenConstantlyIt's hard to recover after physical activity.*NeverSometimesRegularlyOftenConstantly Mental and Emotional StateI feel less self-confident and more hesitant.*NeverSometimesRegularlyOftenConstantlyI don't like the world. I tend to isolate myself.*NeverSometimesRegularlyOftenConstantlyI feel anxious and worried.*NeverSometimesRegularlyOftenConstantlyI tend to worry about things I can't control.*NeverSometimesRegularlyOftenConstantlyI'm feeling drained and I have a hard time handling stress.*NeverSometimesRegularlyOftenConstantlyI feel like my mind is foggy.*NeverSometimesRegularlyOftenConstantlyI feel like I'm living in slow motion.*NeverSometimesRegularlyOftenConstantlyI don't see colors as brightly as before.*NeverSometimesRegularlyOftenConstantlyI have lost interest in art, and don't appreciate it much anymore.*NeverSometimesRegularlyOftenConstantlyI have memory loss.*NeverSometimesRegularlyOftenConstantlyI can't tolerate noise.*NeverSometimesRegularlyOftenConstantlyI am depressed.*NeverSometimesRegularlyOftenConstantlyI cry easily.*NeverSometimesRegularlyOftenConstantlyI'm irritable and aggressive.*NeverSometimesRegularlyOftenConstantlyI lose my self-control.*NeverSometimesRegularlyOftenConstantlyMy close friends complain I am nervous and agitated.*NeverSometimesRegularlyOftenConstantly Menstrual CycleI am still menstruating.*YesNoI do not feel like making love anymore.*NeverSometimesRegularlyOftenConstantlyMy menstrual flow is light.*HeavyModerateLowVery LowNoneMy cycles are irregular, too short, or too long.*NeverSometimesRegularlyOftenConstantlyI have heavy periods.*NeverSometimesRegularlyOftenConstantlyAnd are continuously painful.*NeverSometimesRegularlyOftenConstantlyMy breasts are swollen and tender or painful before my period.*NeverSometimesRegularlyOftenConstantly Sexual HealthI feel like making love less often than I used to*NeverSometimesRegularlyOftenConstantlyMy sexual drive is low.*NeverSometimesRegularlyOftenConstantlyMy sexual performance is poorer than it used to be.*NeverSometimesRegularlyOftenConstantlyI don't have much hair in the pubic area.*PlentyFair AmountBarelyA Few HairsHairlessI don't have much fatty tissue in the pubic area.*Fully PaddedSlightly PaddedFlatSlightly FattyFatMy body doesn't have much of a special scent during sexual arousal.*NeverSometimesRegularlyOftenConstantly Weight and Body ImageMy breasts are getting fatty.*NeverSometimesRegularlyOftenConstantlyMy breasts are droopy.*NeverSometimesRegularlyOftenConstantlyMy breasts are large.*NeverSometimesRegularlyOftenConstantlyMy lower belly is swollen.*NeverSometimesRegularlyOftenConstantlyMy belly is getting fat.*NeverSometimesRegularlyOftenConstantlyMy abdomen is flabby -- I have a spare tire.*NeverSometimesRegularlyOftenConstantlyI put on weight easily.*NeverSometimesRegularlyOftenConstantlyI've lost muscle tone.*NeverSometimesRegularlyOftenConstantlyMy muscles are flabby.*NeverSometimesRegularlyOftenConstantly Sleep and EnergyI have trouble falling asleep at night.*NeverSometimesRegularlyOftenConstantlyMy mind is busy with anxious thoughts while I am trying to fall asleep.*NeverSometimesRegularlyOftenConstantlyI smoke, drink, and/or use a beta blocker as a sleep aid.*NeverSometimesRegularlyOftenConstantlyI sleep light and restlessly.*NeverSometimesRegularlyOftenConstantlyI wake up during the night.*NeverSometimesRegularlyOftenConstantlyAnd I can't get back to sleep.*NeverSometimesRegularlyOftenConstantlyI have trouble getting up in the morning.*NeverSometimesRegularlyOftenConstantlyWhen I get up, I don't feel rested.*NeverSometimesRegularlyOftenConstantlyI feel like I'm living out of sync with the world: going to bed late and waking up late.*NeverSometimesRegularlyOftenConstantlyI cannot tolerate jet lag.*NeverSometimesRegularlyOftenConstantly You have completed this health survey. Please click submit to receive your results.Female Estrogen NumberMale Testosterone NumberFemale Testosterone NumberMale HGH NumberFemale HGH NumberMale DHEA NumberFemale DHEA NumberMale Thyroid NumberFemale Thyroid NumberMale Melatonin NumberFemale Melatonin NumberMale Pregnenolone NumberFemale Pregnenolone NumberFemale Progesterone NumberevwlWeight Loss Heart Health MetabolismevshSexual Health/Performance & HormonesevfeFatigue, Energy, Restorative Sleep & OptimizationevdpAutoimmune, Inflammation & Disease PreventionevmhMental Health, Mood, Clarity & Focus, Emotional SupportcdiaDiabeteschtnHypertensioncdepDepressioncanxAnxietygowlLose Weight/Improve Body Image, CompositiongoieIncrease Energy, Improve MetabolismgoisImprove Sex Drive, Sexual Performance, Sexual FunctiongosbSleep Better, Wake up RestedgomcImprove Mental Clarity & MemorygomoImprove Mood, Positive Outlook, Decrease AnxietygopdPrevent-Delay Future DiseasegoehEliminate Hot Flashes, Night Sweat or Other Age Related SymptomsgofyFeel, Look Younger This iframe contains the logic required to handle Ajax powered Gravity Forms.
