GameDay Men’s Health

Meet our team

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adipiscing elit. Nam laoreet sapien sed efficitur.

Who we are

First name:*

Middle Initial:*

Last name:*

Date of Birth:*

How did you hear about our clinic?*

Email:*

Marital Status:*

Height:*

Weight:*

Street address:*

City*

State:*

Services I am interested in:

HGH Peptides

Shockwave Therapy

Botox/Filler

Hair Restoration

Testosterone Replacement Therapy

Phone:*

Primary Care Doctor (PCP):

Cardiovascular Disease:*

Respiratory Disease:*

Gastrointestinal Disease:*

Genitourinary Disease:*

Do you have any of the following? (Select all that apply)

Diabetes

High Blood Pressure

Cancer

Depression

High Cholesterol

Have you had any previous surgeries?*

Are you taking any prescribed or over-the-counter drugs, such as vitamins and inhalers?*

Allergies to medications:*

How often do you exercise?

Sedentary (No exercise)

Mild exercise

Occasional vigorous exercise

Regular vigorous exercise

Alcohol Use:*

Tobacco Use:*

Do you feel pain or burning with urination?*

Yes

No

Any blood in your urine?*

Yes

No

Do you feel burning discharge from your penis?*

Yes

No

Has the force of your urination decreased?*

Yes

No

Have you had any kidney, bladder, or prostate infections within the last 12 months?*

Yes

No

Date of last prostate and rectal exam?

Date of last colonoscopy?

Mort Ricky

Chief Education Officer
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Alex Portino

VP of Learning
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John Filingo

Director of Academics
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How we work

We are a creative, energetic group

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We are a creative, energetic group

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Lorem ipsum dolor sit amet consectetur adipisicing elit. Fuga, illo!
Lorem ipsum, dolor sit amet consectetur adipisicing elit. Fugit, accusamus.

We are a creative, energetic group

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