Male BioTe- Initial
Name
First Name
Last Name
Age
Weight
Hashimotos?
Yes
No
Currently on Thyroid med?
Yes
No
Currently on Testosterone?
Yes
No
Currently on 5A Reductase?
Yes
No
Experiencing Symptoms?
Yes
No
Urological workup and OK?
Yes
No
Has prostate cancer?
Yes
No
Submit
Should be Empty: