Intake form

Help us serve you better

Name *

Email address *

What is your age?

What is your gender?

What are your primary health concerns?

Please select at least one option.

Fatigue

Weight gain

Mood swings

Low libido

Sleep disturbances

Muscle loss

Have you previously undergone hormone replacement therapy?

Do you have any pre-existing medical conditions?

Are you currently taking any medications?

How did you hear about TRT bakersfield?

Additional questions or comments

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TRT Bakersfield