Part 1 of 4
Symptoms & Experience
Please answer these clinical questions as accurately as possible. your answers are 100% confidential and reviewed only by our medical team
Is this consultation for yourself?
Yes
No
Are you aged between 18 and 75 years old?
Yes
No
Your symptoms
What problem are you experiencing?
Difficulty getting an erection
Difficulty maintaining an erection
Both
How long has this been an issue?
Less than 3 months
3–6 months
More than 6 months
Is the problem:
Ongoing
Occasional
Getting worse
Do you ever have erections (for example, in the morning or during sleep)?
Yes
No
Have you taken any of the following medications in the past Viagra (sildenafil), Levitra (vardenafil), Nipatra, Spedra or Cialis (tadalafil)?
Yes
No
Have you experienced side effect or adverse reactions to any of the above medications?
Yes
No
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