Quizzes & Surveys Archive

GAINSWave Eligibility Quiz

Welcome to GAINSWave Eligibility Quiz!

We are about to ask you a few simple questions to find out if GAINSWave® is right for you.

We value your privacy and your desire to know if this therapy is appropriate for your individual sexual wellness goals. The answers you provide will be collected but not shared outside our office and authorized GAINSWave® medical providers.

Let's get started!

What is your age?

25 - 34

35 - 50

51 - 65

65+

How's your sex life?

Amazing

Can't complain

Could be better

Nonexistent

How's your ability to get and maintain erections?

Excellent

Good

Fair

Low

Can't ever get it up

Do you have a medical condition or take medications that affect sexual performance?

Yes

Don't know

Prefer not to answer at this time

Have you tried other treatments for Erectile Dysfunction (ED)?

Yes

Did other Erectile Dysfunction (ED) treatments work?

Yes

Worked somewhat

Didn't work

How would improving your ability to get and maintain erections affect your life?

It would be life changing

It would improve my life a lot

It would make my life a little more fulfilling

It wouldn't change anything

If you knew there was a treatment that could significantly improve your ability to get and maintain erections, how motivated would you be to follow through with it?

Very motivated!

I'd try my best.

I'd give it a try but I have little trust.

If I see the results right away, I might continue.

Not very motivated. Just looking around.

Captcha. Enter the following text

You are done! To ensure privacy, we'll send you results via email.

Your First Name

Your Email

I agree to receive the results of this evaluation and other communication from CT Hormone Therapy and Integrative MD via email.

Time's up

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Hormone Balance Quiz for Women 2

Welcome to Hormone Balance Quiz for Women 2!

We are about to ask you a few simple questions to help us estimate how balanced your key hormones may be.

Let's get started!

How is your Energy Level?

Like an Energizer Bunny

Tired but enough to get through the day

Too tired after work for anything

Barely make it through the day

How is your mood?

Happy-go-lucky most of the time

Even, neither bad nor good

Mood siwngs, ups and downs

Sad and depressed a lot

How is your mental sharpness?

I am pretty sharp, no complaints

I think I used to be smarter

It's getting harder to keep up with others

Constant brain fog. I've never been like that!

Do you get hot flashes and/or night sweats?

Never

Occasionally

Regularly (once a week or less)

Frequently (more than once a week)

How is your sex drive?

Same I had for years

OK but less than what it used to be 5 years ago

Definitely decreased

Nonexistent

How is your sleep?

Good, I feel fully rested in the morning

I sleep every night but don't feel it's enough

I have trouble falling asleep, wake up often

It's a constant struggle; I feel exhausted in the morning

How often you feel cold without a reason?

Never

Sometimes

Often

Constantly: I never seem to be able to get warm

Losing hair or brittle hair?

Nothing unusual

It's getting noticeably worse

I am beginning to really worry about my hair loss and breakage

It's a disaster! My hair is falling out every day!

Skin getting dry and/or winkled?

Nothing beyond what I consider normal for my age

More than I am willing to accept but nothing serious

I think my skin is beginning to look much older than my age

The way my skin looks is really worrisome, and it's only getting worse.

How are your body weight and shape?

I haven't noticed any recent changes in my weight or the way I look

I've gained a few pounds but in "all the right places"

I've gained quite a few pounds especially around midsection

I've gained a lot of weight and my body shape has changed a lot (big belly, smaller hips, batwings, etc.)

What is your age?

18-35

36-45

46-55

56 +

Captcha. Enter the following text:

That's it! To ensure privacy, we'll send you results via email.

Your First Name

Your Email

I agree to receive the results of this evaluation and other communication from CT Hormone Therapy and Integrative MD via email.

Time's up

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Hormone Balance Evaluation for MEN

Welcome to Hormone Balance Evaluation for MEN!

We are about to ask you a few simple questions to help us estimate how balanced your key hormones may be.

Let's get started!

How is your Energy Level?

Excellent

Tired but enough to get through the day

Too tired after work for anything

Barely make it

How is your mood?

I am usually in good spirits

Neither good nor bad - just OK

Mood swings, ups and downs, get angry easily

Bad most of the time

How is your mental sharpness?

Sharp as a tack

Not what it used to be but I hold my own

Am I getting dumber or are others getting smarter?

I' can't keep up with the pack anymore

How much do you sweat?

Normally - after a workout, on a hot day, etc.

More than I used to

Too often - even others notice it

Often, a lot and for no good reason - something is definitely wrong

How is your sex life?

I haven't noticed any changes in my sex drive or performance

OK but I am slowing down

My drive and/or performance are causing concerns for me and/or my partner

I've lost interest in sex and/or have erectile dysfunction

How is your sleep?

Good, I feel fully rested in the morning

I sleep every night but don't feel it's enough

I have trouble falling asleep, wake up often

It's a constant struggle; I feel exhausted in the morning

How is your muscle strength?

Good, no problems at the gym

It seems lower than before, especially when I push myself

I definitely feel weaker than before

I am getting weaker and look flabby. Workouts don't seem to help.

Joint and Muscle Pain?

Rarely, and then there is always a reason

Occasionally, and it doesn't seem connected to excess workouts or trauma

Frequently forcing me to change my exercise routine or cancel plans

All the time making my life more difficult

How is your endurance?

I have stamina like a horse

I need to take extra breaks when I am doing something strenuous

I need more rest than before even going around my daily routine

I get so tired I need frequent breaks and long periods of rest

Are you gaining weight?

I've been able to keep the same weight and muscle mass for years

I am a few pounds chubbier than I used to be

I hate to admit but my belly is growing

I've got a beer belly while my arms and legs are thinner and less muscular

What is your age?

18-35

36-45

46-55

56 +

Captcha. Enter the following text

That's it! To ensure privacy, we'll send you results via email.

Your First Name

Your Email

I agree to receive the results of this evaluation and other communication from CT Hormone Therapy and Integrative MD via email.

Time's up

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Women Hormone Imbalance

Welcome to Hormone Balance Evaluation for WOMEN!

We are about to ask you a few simple questions to help us estimate how balanced your key hormones may be.

Let's get started!

How is your Energy Level?

Like an Energizer Bunny

Tired but enough to get through the day

Too tired after work for anything

Barely make it through the day

How is your mood?

Happy-go-lucky most of the time

Even, neither bad nor good

Mood siwngs, ups and downs

Sad and depressed a lot

How is your mental sharpness?

I am pretty sharp, no complaints

I think I used to be smarter

It's getting harder to keep up with others

Constant brain fog. I've never been like that!

Do you get hot flashes and/or night sweats?

Never

Occasionally

Regularly (once a week or less)

Frequently (more than once a week)

How is your sex drive?

Same I had for years

OK but less than what it used to be 5 years ago

Definitely decreased

Nonexistent

How is your sleep?

Good, I feel fully rested in the morning

I sleep every night but don't feel it's enough

I have trouble falling asleep, wake up often

It's a constant struggle; I feel exhausted in the morning

How often you feel cold without a reason?

Never

Sometimes

Often

Constantly: I never seem to be able to get warm

Losing hair or brittle hair?

Nothing unusual

It's getting noticeably worse

I am beginning to really worry about my hair loss and breakage

It's a disaster! My hair is falling out every day!

Skin getting dry and/or winkled?

Nothing beyond what I consider normal for my age

More than I am willing to accept but nothing serious

I think my skin is beginning to look much older than my age

The way my skin looks is really worrisome, and it's only getting worse.

How are your body weight and shape?

I haven't noticed any recent changes in my weight or the way I look

I've gained a few pounds but in "all the right places"

I've gained quite a few pounds especially around midsection

I've gained a lot of weight and my body shape has changed a lot (big belly, smaller hips, batwings, etc.)

What is your age?

18-35

36-45

46-55

56 +

Captcha. Enter the following text:

That's it! To ensure privacy, we'll send you results via email.

Your First Name

Your Email

I agree to receive the results of this evaluation and other communication from CT Hormone Therapy and Integrative MD via email.

Time's up

0 Likes4,232 Views0

Quizzes & Surveys

You are done! To ensure privacy, we'll send you results via email.

That's it! To ensure privacy, we'll send you results via email.

That's it! To ensure privacy, we'll send you results via email.

That's it! To ensure privacy, we'll send you results via email.

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