North Bay Naturopathic Clinic

Supplemental Adolescent Intake Male

    Name:
    Birthday:
    Address:
    Email Address:

    Male Reproductive

    At what age did you notice testicular and penile growth?
    Have you ever had a hernia?
    Have you ever noticed any testicular masses?
    Have you experienced testicular pain?
    Are you sexually active?
    Have you ever had a sexually transmitted disease?
    Have you ever noticed any penile discharge?
    What is your sexual preference?