HgH Survey Form

This survey is intended to get a view of your experience with HgH human growth hormone. If you have never used a HgH product please do not send in this form.

* = required field

General
Date of Birth:
Age:	*
Height:	*
Weight:	*
Gender:	Male Female *
Ethnicity:	*
Occupation:	physical activity. *

Reasons for HgH treatment
	Loss of concentration, sociability, activity
	Increasing mood swings
	Decreasing memory
	Increasingly stressed
	Decreased desire and ability to exercise
	Difficulty sleeping
	Decreased sense of well-being
	Increased lack of drive
	Loss of interest in sex
	Depression
	Decreasing size of testicles
	Vaginal dryness
	Urogenital atrophy
	Hot flashes
	Cold or heat intolerance
	Thinning or loss of hair
	Increasing wrinkles
	Sagging, loose or thin skin
	Increasing sagging muscles or breasts
	Muscle loss
	Decreased energy or endurance
	Decrease muscle strength
	Progressive osteoporosis, decreasing bone mass or stooped posture
	Increasing fat deposits about abdomen or thighs
Doctor's Advice:
Other:

Lifestyle
Do you exercise regularly?	Yes No
Type:
Frequency:
Do you follow a healthy dietary regimen?	Yes No
Are you on a diet?	Yes No
If yes, what kind

Used HgH Product
What product did you use:	*
What type of HgH :	*
What was the treatment regimen/dosage:	*
How long did you follow this treatment:	*
Did you achieve satisfactory results:	Yes No *
Did you have your HgH or IGF-1 levels tested:	Yes No *
What did you test?	HgH IGF-1
What kind of test did you use?
What test results did you get (before/after)?
Are you still using this HgH product?	Yes No *
Success Rate:	Poor Low Average Good Exelent *
Price per month in US$:	251+ 76-250 51-75 26-50 0-25 *
Support:	Poor Low Average Good Exelent *
Guarantee:	Poor Low Average Good Exelent *
Ease of use:	Poor Low Average Good Exelent *