Erectile Dysfunction

0%

Kindly Tell Us Your Age

Under 18

18-25

26-69

70 or over

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Please select all the statements that are applicable to you

I've never experienced an erection

I've been diagnosed with cardiovascular disease

I have previously been able to maintain an erection, but I'm now unable to do so reliably.

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Have you had your blood pressure checked within the past 6 months?

Yes

No

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What was the reading of your blood pressure?

Less than 90/50 mmHg (low)

Between 90/50 and 140/90 mmHg (normal)

Above 140/90 mmHg (high)

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15%

Have you tried any of the following treatments before?

Viagra / Sildenafil

Cialis / Tadalafil

Both

None of the above

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Please share your experiences with these treatments, including any side effects you may have had.

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23%

Do any of the following statements apply to you?

I've had a heart attack, stroke, or mini-stroke within the past 6 months.
I have symptoms of chest pain or any heart rhythm irregularities.
I have issues with my heart valves.
I have heart muscle disease.
I become breathless or experience chest pain with light exertion, such as climbing two flights of stairs.
I've been advised to refrain from sexual activity for medical reasons.
I have or have had heart or neurological conditions.

Yes

No

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30%

Do any of the following medical conditions apply to you?

Serious liver problems (like cirrhosis) or kidney problems.
Currently prescribed GTN, Isosorbide mononitrate, Isosorbide dinitrate, Nicorandil (nitrates), or Rectogesic ointment.
Blood pressure abnormality (below 90/50 mmHg or above 160/90 mmHg).
A condition affecting your penis (such as Peyronie's Disease, previous injuries, or inability to maintain an erection due to shape).
Leukemia, multiple myeloma, sickle cell anemia, or a bleeding disorder (like hemophilia).
Stomach ulcers or certain eye diseases like retinitis pigmentosa.
Taking Alpha-blockers (medication for high blood pressure or prostate condition).

Yes

No

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38%

Are you currently on any of the following medications?

Nitrate medications (like GTN spray, isosorbide mononitrate/dinitrate for chest pain, or nicorandil).
Riociguat for pulmonary hypertension.
Recreational drugs (such as 'poppers', 'room odorizers', amyl nitrate, butyl nitrate).

Yes

No

Back

46%

Have you experienced any of the following

Loss of vision in one or both eyes.
Sudden decrease or loss of hearing.
An erection that lasted more than 4 hours (priapism).

Yes

No

Back

54%

Do you agree to the following statement?

I will promptly report any changes in my health or adverse effects to my doctor.

Yes

No

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61%

Are you taking any medications (including over the counter or herbal medicines)? Do you have any other medical conditions not already mentioned?

Yes

No

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Please list all your medications you take and any other medical conditions.

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69%

Does any of the following statements regarding allergies apply to you?

I have an allergy to a medicine or substance

I have lactose intolerance but not a lactose allergy

I have no allergies

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Please list any substances or medicines that you may have allergies to.

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Our tablets contain minuscule amounts of lactose. If you have previously taken a tablet formulation without any symptoms, it's unlikely that you'll experience adverse effects from the lactose in our tablets.

I'm comfortable with proceeding to be assessed for a prescription

I can't tolerate even small amounts of lactose

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74%

Please share with us any significant illnesses, ongoing medical conditions, medications (prescribed or over-the-counter) you're currently taking, allergies to medication, or surgical procedures you've undergone. This information is crucial for our clinicians to ensure the prescribed treatment is safe for you.

I have a significant illness, ongoing medical condition, allergy to medication, or take prescribed or over-the-counter medication to inform you about.

I don't have a significant illness, ongoing medical condition, operation, allergy to medication, or take prescribed or over-the-counter medication to inform you about.

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Please provide more information about your condition or medication.

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85%

Would you like us to inform your GP about your treatment?

Yes

No

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Please provide your GP's contact information?

Continue Back

93%

On average, how often do you anticipate having sex and using these medications?

Less than once per week

1-2 times per week

2-3 times per week

More than 3 per week

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100%

How would you prefer to take your medication?

1 hour before sexual intercourse

I'd rather not plan and take the tablet beforehand

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Before you submit your responses, please review them carefully. Our licensed clinician will go through your answers and get back to you shortly if a prescription is appropriate. By submitting this questionnaire, you are agreeing to our Terms & Conditions and Terms of Sale.

Final Acknowledgment:

Thank you for completing this questionnaire about your health and your experience with erectile dysfunction. Your answers will be reviewed by a licensed clinician on our team to assess if a prescription medication might be appropriate for your condition. They will promptly review your answers and get back to you with suitable suggestions.

Before You Submit Your Responses, Please Affirm That You:

Are Completing This Survey To The Best Of Your Abilities And In A Truthful Manner.
Were Assigned Male At Birth And Are Currently Experiencing Symptoms Of Erectile Dysfunction.
Have Disclosed Any Significant Illnesses Or Surgeries You've Undergone.
Have Disclosed Any Prescription Medication You're Currently Using.
Understand That A Higher Dose Of Sildenafil, Viagra Connect, Or Tadalafil (Non-Daily Dose) Should Only Be Attempted If You've Tried A Lower Dose Several Times In The Past Year Without Success.
Understand That It's Best To Start Tadalafil Daily At A Higher Dose, And Then Decrease To A Lower Dose Once You've Experienced Satisfactory Results.
Will Only Utilise One Method Of ED Treatment At A Time And Will Refrain From Combining More Than One Different Medication For This Condition.
Are Accepting Our Terms & Conditions And Terms Of Sale.

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0%

Kindly Tell Us Your Age

Please select all the statements that are applicable to you

Have you had your blood pressure checked within the past 6 months?

What was the reading of your blood pressure?

15%

Have you tried any of the following treatments before?

Please share your experiences with these treatments, including any side effects you may have had.

23%

Do any of the following statements apply to you?

30%

Do any of the following medical conditions apply to you?

38%

Are you currently on any of the following medications?

46%

Have you experienced any of the following

54%

Do you agree to the following statement?

61%

Are you taking any medications (including over the counter or herbal medicines)? Do you have any other medical conditions not already mentioned?

Please list all your medications you take and any other medical conditions.

69%

Does any of the following statements regarding allergies apply to you?

Please list any substances or medicines that you may have allergies to.

Our tablets contain minuscule amounts of lactose. If you have previously taken a tablet formulation without any symptoms, it's unlikely that you'll experience adverse effects from the lactose in our tablets.

74%

Please provide more information about your condition or medication.

85%

Would you like us to inform your GP about your treatment?

Please provide your GP's contact information?

93%

On average, how often do you anticipate having sex and using these medications?

100%

How would you prefer to take your medication?

Final Acknowledgment:

Before You Submit Your Responses, Please Affirm That You:

We are creating your personalized recommendations.

This will only take couple of seconds

0%

Kindly Tell Us Your Age

Please select all the statements that are applicable to you

Have you had your blood pressure checked within the past 6 months?

What was the reading of your blood pressure?

15%

Have you tried any of the following treatments before?

Please share your experiences with these treatments, including any side effects you may have had.

23%

Do any of the following statements apply to you?

30%

Do any of the following medical conditions apply to you?

38%

Are you currently on any of the following medications?

46%

Have you experienced any of the following

54%

Do you agree to the following statement?

61%

Are you taking any medications (including over the counter or herbal medicines)? Do you have any other medical conditions not already mentioned?

Please list all your medications you take and any other medical conditions.

69%

Does any of the following statements regarding allergies apply to you?

Please list any substances or medicines that you may have allergies to.

Our tablets contain minuscule amounts of lactose. If you have previously taken a tablet formulation without any symptoms, it's unlikely that you'll experience adverse effects from the lactose in our tablets.

74%

Please provide more information about your condition or medication.

85%

Would you like us to inform your GP about your treatment?

Please provide your GP's contact information?

93%

On average, how often do you anticipate having sex and using these medications?

100%

How would you prefer to take your medication?

Final Acknowledgment:

Before You Submit Your Responses, Please Affirm That You:

Your safety is our top priority.

Unfortunately, we can’t offer you any ED medication.

We are creating your personalized recommendations.

This will only take couple of seconds