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REQUEST A CONSULT

(951) 498-7853

Start Your Journey, Gentlemen!

Celebrate the first stride towards revitalizing your vitality and well-being. This assessment signals the commencement of your journey towards a healthier, enhanced self. Share any symptoms you've encountered, and together, we'll pave the path to your improved health.

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
Severe
Very Severe
No elements found. Consider changing the search query.
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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)

Choose One

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)

Choose One

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

Ejaculations (infrequent or absent)

Choose One

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)

Choose One

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

Choose One

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

Choose One

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)

Choose One

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

Weight (difficulty losing weight despite diet/exercise)

Choose One

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:

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Feeling Like YOU, Like Never Before!

We are excited to meet you and help you feel your best.

First Name *

Last Name *

Email *

Mobile Phone *

Patient Status *

New or Returning Patient

New patient
Returning patient
No elements found. Consider changing the search query.
List is empty.

Appointment Type *

Select one:

Bioidentical Hormone Therapy Replacement
Hormone Injection
Other Services
No elements found. Consider changing the search query.
List is empty.

Special Concerns or Questions?

I agree to terms & conditions and privacy policy provided by the company. By providing my phone number, I agree to receive text messages from the business. Reply STOP to unsubscribe.

Feeling Like YOU, Like Never Before!

We are excited to meet you and help you feel your best.

First Name *

Last Name *

Email *

Mobile Phone *

Patient Status *

New or Returning Patient

New patient
Returning patient
No elements found. Consider changing the search query.
List is empty.

Appointment Type *

Select one:

Bioidentical Hormone Therapy Replacement
Hormone Injection
Other Services
No elements found. Consider changing the search query.
List is empty.

Special Concerns or Questions?

I agree to terms & conditions and privacy policy provided by the company. By providing my phone number, I agree to receive text messages from the business. Reply STOP to unsubscribe.

About Us

At IgniteRx Medical, we're dedicated to providing personalized hormone therapy programs using advanced techniques to restore balance and enhance well-being.