Men’s Health Questionnaire

Are you unsure if you qualify to be a part of our Vibrance By Hometown Men's Health Program?

Get started by answering 5 short questions. Our team will contact you shortly after you submit this questionnaire.

Name

Do you have a decrease in libido (sex drive)?

Yes No

Do you have a lack of energy?

Yes No

Do you have a decrease in strength and/or endurance?

Yes No

Are you sad and/or grumpy?

Yes No

Are your erections less strong?

Yes No

Is there any other information you want to share with our team?

*Results may vary based on individual circumstances.

At Vibrance by Hometown, our mission is to ignite a transformative journey towards optimal well-being. By integrating cutting-edge strategies and holistic approaches, we empower individuals to elevate every aspect of their lives from physical vitality to mental clarity. We are dedicated to fostering a vibrant community where every step taken leads to a more dynamic and fulfilling existence.

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Thank you for completing the men’s health questionnaire. Our team will be in contact with you to discuss your responses and next steps.

Men’s Health Questionnaire

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