Hormone Replacement Therapy – Medication Refill Form

At Sana Vida Wellness Center, we use a simple set of questions to determine if Hormone Replacement can benefit you. This assessment can also help us find the most accurate way for us to approach your specific treatment plan.

Patient Information

1. Have you visited with your PCP or Specialist since starting the program?

1.2. Is blood work performed?

3. Have you noticed a increase of muscle mass, strength or endurance?

4. Do you have an increased sex drive?

5. Do you feel more energetic than prior to starting HRT?

6. Do you find yourself having less difficulty concentrating or focusing?

10. Are you happy with your current testosterone replacement therapy protocol?

13 + 4 =

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