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Medical Assessment for Erectile Dysfunction Releif

Complete this short online consultation so our medical team can show you suitable treatments.

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Tell us about yourself
Are you male and between 18 and 75 years of age?
Do you smoke or drink?
Have you taken Viagra (sildenafil), Levitra (vardenafil), Nipatra, Spedra or Cialis (tadalafil) at least 4 times previously without any side effects?
About Your Symptoms
Do you have trouble achieving or maintaining your erection?
Your Health Information
Do you have any allergy to Viagra (sildenafil), Levitra (vardenafil), Spedra (avanafil) or Cialis (tadalafil) or have you experienced any adverse reaction to any erectile dysfunction medication previously?
Do you have high blood pressure (above 160/90), or are you currently on treatment for high blood pressure?
Do you have low blood pressure (below 90/50)?
Do you suffer from depression for which you have not seen a GP?
Have you been advised to avoid strenuous exercise?
Have you ever suffered from any of the problems listed below?
Would you have any difficulty walking at a fast pace for 5 minutes?
Your Current Medication
Are you currently taking any medication (over-the-counter or prescription) or any recreational drugs?
Are you taking any medicines known as nitrates (often taken for chest pain/angina) or nitric oxide donors ('poppers')?
Patient Declaration & Agreements
Do you agree to the following?
Do you understand that erectile dysfunction can be associated with a number of contributing health conditions (e.g. hypertension, diabetes mellitus, high cholesterol or cardiovascular disease) and you should consult your doctor within 6 months of starting treatment for a clinical review?
In the rare event I obtain a prolonged erection of more than 4 hours or experience any sudden visual impairment, I agree that I will seek immediate medical assistance.