Men's General Health Data Collection by Dr Mtonga N. Isaac

 

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First Name Surname Age Township Town/City Phone Number Country

Men's General Health Data Collection

Do you experience erectile dysfunction? Yes No

Do you have low sex drive? Yes No

Have you noticed a decrease in semen volume? Yes No

Do you experience pain during ejaculation? Yes No

Have you had a vasectomy or vasectomy reversal? Yes No

Do you have a history of undescended testes? Yes No

Have you experienced testicular trauma or injury? Yes No

Do you have a varicocele (enlarged veins in the scrotum)? Yes No

Have you been diagnosed with a hormonal imbalance? Yes No

Do you take medications that affect fertility? Yes No

Have you been exposed to toxins or chemicals? Yes No

Have you undergone cancer treatment? Yes No

Have you experienced frequent urinary tract infections? Yes No

Do you have a family history of infertility or genetic disorders? Yes No

Have you had any issues with your prostate, such as prostatitis or an enlarged prostate? Yes No

Do you experience premature ejaculation? Yes No

Do you sometimes experience high blood pressure or dizziness? Yes No

Have you noticed a decrease in muscle mass or strength? Yes No

Have you experienced frequent fevers or infections? Yes No

Do you experience sexual feelings? Yes No

Do you smoke? Yes No

Do you consume alcohol excessively? Yes No

Do you have any information about your health? Write here (Optional, 5000 characters)

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