Lifestyle Review Questionnaire for Dads Again "*" indicates required fields Lifestyle Review QuestionnaireFirst and Last Name:* Date of Birth:* MM slash DD slash YYYY Medical Review Since Your ReversalHave you had any fevers or illnesses since your reversal?*How often are you icing?* Have you been diagnosed with any new diseases or started any new treatments?* Do you have any consistent vibrations on your groin?*Have you taken part in Hot Tubs, Jacuzzis, Hot Saunas, Hot Baths, Laptop on the Lap for Extended periods of time? Please, elaborate:*Medications & SupplementsAre you taking testosterone?* Yes No If yes, when did you start? How much are you taking and how often are you taking it?How are you tolerating the NSAIDs (Aleve, Ibuprofen, Meloxicam)? Are you still taking them? What is your regimen?* How are you tolerating the steroids (Prednisone, Medial)? Are you still taking them? What is your regimen?* Have you started any new medication(s) or supplements since your reversal?* Yes No Elaborate (what you are taking, regimen): How often are you exercising? What type of exercise are you taking part in? (If you ride bikes, please include how often and when you started)*Have you started a new diet or changed your diet since your reversal? Please, elaborate:*Recreational Drug UseAre you drinking alcohol?* Yes No How often / how much on a daily/weekly basis?* Are you smoking cigarettes?* Yes No How often / how much on a daily/weekly basis?* Do you smoke or consume marijuana?* Yes No How often / how much on a daily/weekly basis?* Thank you for completing our Lifestyle Review Questionnaire! « Previous PostNext Post »
