STEP 1 / 18 Do you ever have a problem getting or maintaining an erection that is rigid enough for sex?
STEP 2 / 18 Do you get erections...
STEP 3 / 18 Have you ever been formally treated for ED or tried any medicines, vitamins, or supplements to treat it?
STEP 4 / 18 Have you had a physical exam with a healthcare provider in the past 5 years?
STEP 5 / 18 Was your blood pressure taken in the past year?
STEP 6 / 18 Do you take any medications, vitamins, or supplements regularly?
STEP 7 / 18 Do you take any of the following medicines? Select all that apply.
STEP 8 / 18 Do you have any allergies?
STEP 9 / 18 Do you have any medical conditions or history of prior surgeries?
STEP 10 / 18 Do any of the following cardiovascular risk factors apply to you?
Tell us more about your diabetes. When was your last Hemoglobin A1c checked and what was the value?
Tell us more about your high cholesterol
Tell us more about your high blood pressure
STEP 11 / 18 Do you have or have you previously been diagnosed with any of the following? Check all that apply.
Condition
Tell us more about
STEP 12 / 18 Do you experience any of the following cardiovascular symptoms?
Condition
Please tell us more about your prolonged leg cramps.
STEP 13 / 18 Do you use any of the following recreational drugs? Subtext: Severe reactions may result if ED meds are used in conjunction with recreational drugs.
Drug
Tell us more about
STEP 14 / 18 Do you have any of the following conditions? Select all that apply.
Drug
STEP 15 / 18 Do you have now, or have you ever had any of the following conditions?
Condition
Tell us more about your
Tell us more about your
STEP 16 / 18 Is there anything else you want your doctor to know about your condition or health?
STEP 17 / 18 Is there anything else you want your doctor to know about your condition or health?
SILDENAFIL 20 MG
SILDENAFIL 50 MG (GENERIC VIAGRA®)
SILDENAFIL 100 MG (GENERIC VIAGRA®)
TADALAFIL 5MG (GENERIC CIALIS®)
TADALAFIL 10MG (GENERIC CIALIS®)
TADALAFIL 20MG (GENERIC CIALIS®)
Let the doctor recommend
STEP 18 / 18 In order to verify your identity, please upload a picture of your government-issued photo ID.
