The Program is designed to support health and our doctors do not advise in cases of chronic or acute diseases, critical conditions, nor they consult children under 18.
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Full name *
Sex *
Date of birth *
Phone number *
Which messenger is more convenient for contact? *
Do you have any allergiеs (medications, food allergies)? *
Are you intolerant to any medications, herbs or dietary supplements? *
Do you now have a history of cancer? (If so, indicate when and what exactly) *
What serious diseases have you suffered in the last 2 years? *
The recent stress has had a profound effect on me. *
I'm scared and anxious, even if I'm in a relatively safe place. *
It often seems to me that something bad is about to happen and I have restless thoughts for no objective reason. *
Sometimes I have a fast heartbeat for no objective reason. *
Things don’t bring the same level of joy as before. For example, I can't enjoy a cup of coffee like I used to. *
I often have a depressed and apathetic mood, regardless of the news. *
I pay less attention to my appearance and less often smile even at the good news. *
I have a tendency to depression *
I have decreased tolerance for stressful situations *
I've been feeling annoyed lately; I am very annoyed even by a slight noise *
It is difficult for me to fall asleep even in silence and relatively comfortable conditions *
I wake up at night without external influences (air raid sirens, loud sounds) *
A night's sleep does not bring vigor and it is difficult for me to get out of bed in the morning. *
After sleep I have a slightly hoarse voice. *
Lately I work a lot and hard, I get tired and almost do not rest *
Lately I’ve become less productive at work *
My thinking has slowed down, I make mistakes when I'm in a hurry or under pressure *
My mental processes and mental acuity have decreased significantly *
Recently, my memory has deteriorated significantly *
 I have a bad memory for recent events *
Lately it has become difficult for me to concentrate on current tasks *
I had self-doubt and weak motivation to act *
I often feel weak and drowsy in the afternoon *
I constantly feel very tired, it does not pass even after a night's sleep *
When I rise sharply from a horizontal position, I feel dizzy *
Sometimes I feel that I’m going to loose consciousness for no objective reason *
I have a tendency to hypotension (low blood pressure *
I get tired quickly from physical exercises *
I noticed that I became less sweaty even with intense exercise *
I often have sore muscles and joints *
Recently, the mobility of my joints has decreased significantly *
My muscles have lost tone, strength and elasticity *
Recently, the amount of my muscle mass has decreased, and fat, on the contrary, has increased *
I have difficulty losing weight *
I am prone to rapid weight gain *
I have a tendency to deposit fat in the abdomen *
Recently, I have developed fat deposits in the chest and thighs *
I have digestion problems when I am in a stressful situation *
I have a tendency to constipation (stool less than once a day) *
I have high blood cholesterol *
I often suffer from SARS and ARI, feel under the weather *
I have had frequent allergic reactions that I did not have before *
I have an intolerance to low temperatures *
I often have cold feet and hands *
My ankles sometimes swell and the swelling worsens in the evening *
I have swelling of the face and eyelids in the morning *
Recently, my skin has become drier and needs intense hydration *
Recently, I’ve noticed that my mucous membranes are less moisturized *
Recently, my skin has become thinner and less elastic *
Lately I've been losing a lot of hair on my head *
Recently, the amount of my body hair has decreased *
The outer part of my eyebrows is thinner than the middle or inner part *
Recently, my libido has decreased and I’m experiencing some difficulties in achieving sexual pleasure *
I have a menstrual disorder
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I am pregnant / lactating
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I have abnormalities in the prostate gland (frequent nocturnal urination, urinary retention, incomplete bladder emptying, diagnosed prostatitis or prostate adenoma, etc.). If so, please specify.
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Recently, I may have difficulty getting an erection during intercourse
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