Divine naturopathic clinic & wellnes center lorgo

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Empower Your Self: Begin Your Journey

Unlock your potential with a deeper understanding of how hormones impact your daily performance, vitality, and well-being. Our male hormone assessment is designed to identify imbalances that could be affecting your mood, energy, strength, and focus.

Take The Male Health Assessment Survey

Male Health Assessment

First Name

Last Name

Email *

Phone *

Symptoms

Please mark the appropriate box for each symptom you may be experiencing.

Physical Exhaustion (fatigue, lack of energy, stamina or motivation)

Choose One

None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Sleep Problems (difficulty falling asleep or sleeping through the night)

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None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Irritability (mood swings, feeling aggressive, angers easily)

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None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Anxiety (feeling overwhelmed, feeling panicky, or feeling nervous)

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None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Decline in drive or interest (loss of “zest for life,” feeling down or sad)

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None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Joint and muscular symptoms (joint pain, muscle weakness, poor recovery after exercise)

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None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Difficulties with memory (concentration, finding the right word, or retaining information)

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None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Sexual Desire or Performance (reduced or diminished)

Choose One

None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Erectile changes (weaker erections, loss of morning erections)

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None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Ejaculations (infrequent or absent)

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None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Sweating (night sweats or increased episodes of sweating)

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None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Hair loss, thinning or change in texture of hair

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None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Feeling cold all the time, having cold hands or feet

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None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Headaches or migraines (increase in frequency or intensity)

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None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Weight (difficulty losing weight despite diet/exercise)

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None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Bladder problems (difficulty in urinating, increased need to urinate, incontinence)

Choose One

None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Other symptoms or unique health circumstances to take into consideration:

By providing your phone number, you agree to receive text messages from Divine Naturopathic Clinic for appointment details and other informational text messages. Message and data rates may apply. Message frequency may varies.

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About Us

Personalized naturopathic medicine to restore balance, enhance vitality, and support natural wellness.

Address: 1715 Market Street, Suite 103, Kirkland, WA 98033

Phone: 425 785 1913

Hours of Operation:
Monday- Friday
9:00 am- 5:00 pm