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"ONLINE T-HORMONE" FERTILITY TEST


atas

EMAIL ADDRESS Alamat Emel
TERMS AND CONDITIONS Terma dan syarat
term

NAME NAMA
AGE UMUR
CONTACT NUMBER NOMBOR TELEFON
WEIGHT(KG) BERAT
HEIGHT (CM) TINGGI

SECTION B - HEALTH TEST

"ORAL ASSESSMENT" OF YOUR MEN'S HEALTH LEVEL

PLEASE FILL ALL THE INFORMATION BELOW CORRECTLY

DO YOU SMOKE? ADAKAH ANDA SEORANG PEROKOK?
DO YOU EXERCISE AT LEAST 4 TIMES A WEEK? ADAKAH ANDA BERSENAM SEKURANG-KURANGNYA 4 KALI SEMINGGU?
DO YOU HAVE ANY OF THESE ILLNESS? SILA NYATAKAN JIKA ANDA MEMPUNYAI SEBARANG PENYAKIT?
DO HAVE "MORNING WOOD" EVERYDAY? ADAKAH ANDA MENDAPAT EREKSI PAGI SETIAP HARI?
HAVE YOU EXPERIENCE PREMATURE EJACULATIONS? ADAKAH ANDA MENGALAMI MASALAH PANCUT AWAL?
DO YOU HAVE TROUBLE MAINTAINING ERECTION DURING INTERCOURSE? ADAKAH ANDA MENGALAMI MASALAH UNTUK MENGEKALKAN EREKSI?