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ADAM Questionnaire for Male Seniors

Before seeing your physician, you might want to print out and then complete the following ADAM questionnaire. It will help your doctor and you better manage your medical needs. Answer as many questions as you can.

Do you have a decrease in libido?
Yes
No

Do you have a lack of energy?
Yes
No

Do you have a decrease in strength and/or endurance?
Yes
No

Do you have a decreased enjoyment of life?
Yes
No

Are you sad?
Yes
No

Are you grumpy?
Yes
No

Are your erections less strong?
Yes
No

Have you noticed a recent deterioration in your ability to play sports?
Yes
No

Are you falling asleep earlier after dinner?
Yes
No

Has there been a recent deterioration in your work performance?
Yes
No

Medical Questionnaire Geriatric Depression Scale
CAGE Epworth Sleepiness Questionnaire




  

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