Overcome Average Clinics
What will you overcome?

Lab Report and Consultation - Questionnaire | Overcome Average

Our questionnaire provides us with the information necessary to provide our customers with lab reports and consultation services.

 Please Fill Out the Information and QUESTIONNAIRE Below

Name *
Name
Address *
Address
Phone *
Phone
Survey *
Survey
Irritable
Anxiety
Discouragement/Pessimism
Decreasing interest in Activities/Relationships
Decreased Initiative/Motivation/Drive
Decreased productivity at work
Concentration problems
Satisfied with Physical Apperance
Foggy Thinking
Decrease in Strength/Stamina
Decrease in athletic performance
Muscle soreness/weakness
Weight Gain
Increased fat on hips/breast/thigh
Caffeine/Stimulant Cravings
Head Hair Loss
Dry skin/Thinning Skin
Decreased Spontaneous Morning Erections
Lowered Libido
Erectile Dysfunction
Frequent Need to Urinate