This confidential questionnaire must be completed prior to your scheduled appointment. Your responses help our pharmacy team review relevant health information related to erectile dysfunction and low testosterone so your consultation can be focused, efficient, and productive. All information is kept private.
If you have not yet scheduled a consultation, please do so before completing this form.
Please complete and submit this questionnaire at least 24 hours before your scheduled consultation. Fill out the form below to start improving your sexual health today.
Now offering MDLifespan’s physician-led PlasmaXchange™ detox therapy — exclusively at Town & Country Compounding
Have questions or need guidance? Our knowledgeable pharmacy team is here to provide personalized support and clear next steps.
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