Personalized Health Survey | 25 Again

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FREE SURVEY

Our Process
Assessments
Locations
Education
My Account
About
Shop 25 Again
FREE SURVEY

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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*
Your City*
Next, tell us your gender.*
- Female
- Male
And now, enter your birth date:*
By clicking next, you are confirming that your birth date is accurate, agree to survey disclosure & grant permission for 25 Again to communicate with you via text messages concerning appointment scheduling and other relevant information. Msg & data rates may apply.

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?*
- Yes
- No
Do you take medications to control blood pressure?*
- Yes
- No
Have you been told you are pre-diabetic or diabetic?*
- Yes
- No
Do you take medications to control diabetes?*
- Yes
- No
Have you ever had a panic attack?*
- Yes
- No
Do you take medications for depression?*
- Yes
- No

Next, tell us your goals.
Please rate the importance of addressing these goals for your health today.
Lose Weight/Improve Body Image, Composition*
- Very Important
- Important
- Moderately Important
- Of Little Importance
- Not Important
Increase Energy, Improve Metabolism*
- Very Important
- Important
- Moderately Important
- Of Little Importance
- Not Important
Improve Sex Drive, Sexual Performance, Sexual Function
- Very Important
- Important
- Moderately Important
- Of Little Importance
- Not Important
Sleep Better, Wake up Rested*
- Very Important
- Important
- Moderately Important
- Of Little Importance
- Not Important
Improve Mental Clarity & Memory*
- Very Important
- Important
- Moderately Important
- Of Little Importance
- Not Important
Improve Mood, Positive Outlook, Decrease Anxiety*
- Very Important
- Important
- Moderately Important
- Of Little Importance
- Not Important
Prevent-Delay Future Disease*
- Very Important
- Important
- Moderately Important
- Of Little Importance
- Not Important
Eliminate Hot Flashes, Night Sweat or Other Age Related Symptoms*
- Very Important
- Important
- Moderately Important
- Of Little Importance
- Not Important
Feel, Look Younger*
- Very Important
- Important
- Moderately Important
- Of Little Importance
- Not Important

Tell us what's going on, what symptoms do you face?
To the best of your ability, please answer the questions below:
Physical Issues
My feet are too hot at night.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
My hands and feet are always cold.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I have hot flashes and sweats.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I'm sensitive to cold.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
My joints hurt (fingers, wrists, elbows, feet, ankles, knees).*
- Never
- Sometimes
- Regularly
- Often
- Constantly
My joints are stiff.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I am constipated.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I crave salty.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I have abundant, light-colored urine during the day.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I have low blood pressure.*
- Never
- Sometimes
- Regularly
- Often
- Constantly

Physical Appearance
My face has become slack and more wrinkled.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
My cheeks sag.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
My hair is thinning.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
My gums are receding.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
My hair is dry.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
My skin and eyes are dry.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
My skin is thin and/or dry.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I look older than I am.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I have dry skin.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
In the morning, my face is puffy and my eyelids are swollen.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I'm losing hair under my arms or in my pubic area.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I am losing hair on top of my head.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I'm getting thin, vertical wrinkles above my lips.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
My eyes are dry and easily irritated.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
My face is too hairy.*
- Never
- Sometimes
- Regularly
- Often
- Constantly

Exercise and Stamina
I tire easily with physical activity.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I am constantly tired.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I feel exhausted.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
It's hard to recover after physical activity.*
- Never
- Sometimes
- Regularly
- Often
- Constantly

Mental and Emotional State
I feel less self-confident and more hesitant.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I don't like the world. I tend to isolate myself.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I feel anxious and worried.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I tend to worry about things I can't control.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I'm feeling drained and I have a hard time handling stress.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I feel like my mind is foggy.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I feel like I'm living in slow motion.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I don't see colors as brightly as before.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I have lost interest in art, and don't appreciate it much anymore.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I have memory loss.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I can't tolerate noise.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I am depressed.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I cry easily.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I'm irritable and aggressive.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I lose my self-control.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
My close friends complain I am nervous and agitated.*
- Never
- Sometimes
- Regularly
- Often
- Constantly

Menstrual Cycle
I am still menstruating.*
- Yes
- No
I do not feel like making love anymore.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
My menstrual flow is light.*
- Heavy
- Moderate
- Low
- Very Low
- None
My cycles are irregular, too short, or too long.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I have heavy periods.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
And are continuously painful.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
My breasts are swollen and tender or painful before my period.*
- Never
- Sometimes
- Regularly
- Often
- Constantly

Sexual Health
I feel like making love less often than I used to*
- Never
- Sometimes
- Regularly
- Often
- Constantly
My sexual drive is low.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
My sexual performance is poorer than it used to be.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I don't have much hair in the pubic area.*
- Plenty
- Fair Amount
- Barely
- A Few Hairs
- Hairless
I don't have much fatty tissue in the pubic area.*
- Fully Padded
- Slightly Padded
- Flat
- Slightly Fatty
- Fat
My body doesn't have much of a special scent during sexual arousal.*
- Never
- Sometimes
- Regularly
- Often
- Constantly

Weight and Body Image
My breasts are getting fatty.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
My breasts are droopy.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
My breasts are large.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
My lower belly is swollen.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
My belly is getting fat.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
My abdomen is flabby -- I have a spare tire.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I put on weight easily.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I've lost muscle tone.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
My muscles are flabby.*
- Never
- Sometimes
- Regularly
- Often
- Constantly

Sleep and Energy
I have trouble falling asleep at night.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
My mind is busy with anxious thoughts while I am trying to fall asleep.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I smoke, drink, and/or use a beta blocker as a sleep aid.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I sleep light and restlessly.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I wake up during the night.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
And I can't get back to sleep.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I have trouble getting up in the morning.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
When I get up, I don't feel rested.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I feel like I'm living out of sync with the world: going to bed late and waking up late.*
- Never
- Sometimes
- Regularly
- Often
- Constantly
I cannot tolerate jet lag.*
- Never
- Sometimes
- Regularly
- Often
- Constantly

You have completed this health survey. Please click submit to receive your results.
Female Estrogen Number
Male Testosterone Number
Female Testosterone Number
Male HGH Number
Female HGH Number
Male DHEA Number
Female DHEA Number
Male Thyroid Number
Female Thyroid Number
Male Melatonin Number
Female Melatonin Number
Male Pregnenolone Number
Female Pregnenolone Number
Female Progesterone Number
evwl
Weight Loss Heart Health Metabolism
evsh
Sexual Health/Performance & Hormones
evfe
Fatigue, Energy, Restorative Sleep & Optimization
evdp
Autoimmune, Inflammation & Disease Prevention
evmh
Mental Health, Mood, Clarity & Focus, Emotional Support
cdia
Diabetes
chtn
Hypertension
cdep
Depression
canx
Anxiety
gowl
Lose Weight/Improve Body Image, Composition
goie
Increase Energy, Improve Metabolism
gois
Improve Sex Drive, Sexual Performance, Sexual Function
gosb
Sleep Better, Wake up Rested
gomc
Improve Mental Clarity & Memory
gomo
Improve Mood, Positive Outlook, Decrease Anxiety
gopd
Prevent-Delay Future Disease
goeh
Eliminate Hot Flashes, Night Sweat or Other Age Related Symptoms
gofy
Feel, Look Younger
Name
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*Individual results may vary from person to person. The content of this website is for informational purposes only. Only a qualified medical provider can determine if you qualify for treatment. Contact us to schedule an appointment with one our qualified medical providers.

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