• Men's Health Assessment

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    Pick a Date
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  • Symptoms

    Please rate each symptom below as: Never, Mild, Moderate, or Severe
  • Severity score: Mild:1-20 / Moderate 21-40 / Severe 41-60 / Very Severe 61-80
  • Family History

  • Do any of these apply to you?

  • The Sexual Health Inventory for Men (SHIM) Questionnaire

    Over the past 6 months...
  • Should be Empty: