Erectile Dysfunction
Before we are able to prescribe any medication to treat your Erectile Dysfunction, we are going to ask you some questions to ensure it is safe and appropriate for us to issue a prescription. The answers to these questions are reviewed by a prescribing clinician who will then authorise the treatment. Before proceeding to these questions, please accept the following:
- You were assigned male at birth and are currently over 18 years of age
- You are experiencing some form of Erectile Dysfunction
- The treatment prescribed will only be taken by yourself
- You will alert us to any serious conditions you may have and/or any procedures performed on yourself
- You will alert us to any prescription medication you are taking
- You will only use one Erectile Dysfunction treatment at a time
- You agree to our terms and conditions
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How old are you?
Have you had an allergic reaction to any of the following?
Select all the following statements that apply to you
Do you take any of the following medications?
Have you taken, or are you currently taking any of the following treatments for erectile dysfunction?
Do you smoke?
Is there anything else you feel we should know in order to ensure it is safe for us to prescribe our treatments? For example other health conditions, medication that you are taking, procedures you have had.
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