Hormone Questionnaire

Free Hormone Panel Eligibility Questionnaire

Thank you for your interest in our Free Hormone Panel & Consultation. Please answer the questions below to help us determine if hormone testing may be appropriate for you.

Which of the following symptoms are you currently experiencing? (Check all that apply)

Fatigue or low energy Weight gain or difficulty losing weight Brain fog or poor concentration Low libido Poor sleep Mood changes, irritability, or anxiety Hot flashes or night sweats Reduced muscle mass or strength None of the above

How long have you been experiencing these symptoms?

Less than 3 months 3–6 months 6–12 months More than 1 year

Have you previously had your hormone levels tested or received hormone therapy?

No Tested, but never received treatment Currently receiving hormone therapy Received hormone therapy in the past

If testing indicates a hormone imbalance, would you be interested in learning about treatment options?

Yes Maybe, I would like more information No

Preferred Contact Method

Phone Email

Your Name *

Phone Number*

Email*

disclaimer

At Restorative Health of Colorado, all information on this site has been verified by our certified medical board to ensure accuracy and trust. Content is for educational purposes only and not a substitute for professional medical advice. For personalized care, please schedule a consultation with our licensed providers.

Angela's Bio

Info

12905 West 40th Ave, Suite 105, Golden, CO 80401

720-262-5787

Info@reshealthco.com

Mon-Fri 9:30AM - 5:30PM
Sat: By Appointment Only

@restorativehealthcolorado
@restorativehealthcolorado

Offering Veteran and First Responder Discounts

Service Areas

Lakewood • Wheat Ridge • Golden • Evergreen • Arvada • Denver

Home
Our Team
About Us
Privacy Policy
HIPPA
TERMS & CONDITIONS