What we treat
Men's Health
Erectile Dysfunction
Premature Ejaculation
Hair Loss
Women's Health
Period Delay
Combined Pill
Mini Pill
Alternatives to the pill
General Health
Asthma
Migraine
Acid Reflux
Weight Loss
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Erectile Dysfunction
Are you male?
Yes
No
Do you believe you have the capacity to make decisions about your own healthcare?
Yes
No
Have you been diagnosed with any medical conditions?
Yes
No
Please provide more information, including diagnosis, symptoms and treatment.
Are you currently taking any medication? This includes prescription-only, over-the-counter and homeopathic medicines.
Yes
No
Which medication, what strength and how often are you taking it?
Do you suffer from any allergies?
Yes
No
What allergies do you have and what are the symptoms you experience from an allergic reaction?
Is there anything else you would like to include for the prescriber?
Yes
No
Please provide further information:
Do you suffer from any heart, liver or kidney problems?
Yes
No
Please provide further details
Have you ever had a heart attack or stroke?
Yes
No
When was this? (month/year)
Do you suffer from low blood pressure (below 90/50) or experience faints or collapsing because of it?
Yes
No
Can you always get an erection when you want?
Yes
No
Has your GP ever advised you that you are not fit enough for any physical or sexual activity?
Yes
No
Do you suffer from any condition affecting the shape of your penis?
Yes
No
Please provide more information about your condition.
Have you ever experienced an erection lasting longer than 4 hours?
Yes
No
Do you suffer from any eye conditions such as non-arteritic ischaemic optic neuropathy, retinal problems or retinitis pigmentosa?
Yes
No
Do you suffer from stomach/duodenal ulcers or blood conditions such as sickle cell, haemophilia or bleeding disorders?
Yes
No
Do you suffer from diabetes?
Yes
No
Have you tried any erectile dysfunction medication before?
Yes
No
What have you tried before (including dose)?
Do you agree to the following?
You agree to our terms and conditions, privacy policy and acceptable use policy
You will read the Patient Information Leaflet supplied with your medication
The treatment is solely for your own use
You are aware you will be subject to a soft check to validate your identity via Yoti
You have answered all the above questions accurately and truthfully
You understand the prescriber will take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health
You will inform your GP of this purchase if appropriate
Yes
No
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