Optional but recommended. Bring results to the session if you have them.

Check every area that matters to you. Note your single top priority in the box below.

How you have felt recently. Answer Yes or No to each.

Check all that apply, current or past.

Siblings, parents, grandparents.

Do you CURRENTLY have any of these? Check all that apply.

Answer each for the PAST 4 WEEKS. Enter 0–5 in each box; the total updates automatically.

Check what you have tried and note the result / dose.

List anything you take outside standard prescriptions, including research chemicals from any source. No judgment; it changes what is safe to recommend.

Include anything you take regularly, including items from online or non-standard sources. Add rows as needed.

Untreated sleep problems lower testosterone and blunt results.

Chance of dozing: 0 never · 1 slight · 2 moderate · 3 high. Total updates automatically.

The information I receive in this consultation is for educational purposes only and is not a substitute for the advice of a qualified health care provider. I understand that medical therapy and the use of compounds like testosterone should be tailored to the individual. Nelson Vergel does not recommend self-medicating with any compound; I should consult a qualified physician who can assess my individual situation. Any use of the educational information from this session is at my own risk, with no responsibility implied on the part of Nelson Vergel.