About your General Health To help us provide the right treatment or advice for you, please answer the following questions about your overall health. If you get stuck or need any help, you can contact us.
0%
Back Do you currently suffer with difficulty getting or maintaining an erection?
Has a healthcare professional or any body else ever advised that you are not fit enough for sexual activity?
Have you previously used any tablets for erectile dysfunction?
If you have previously used erectile dysfunction treatment- did you ever experience any side effects?
Have you ever experienced low blood pressure (BP below 90/50) or ever fainted or collapsed due to your blood pressure?
Have you ever previously been diagnosed with any heart conditions or had any major health incidents involving the heart? (e.g. Heart attack or stroke)
Have you ever been diagnosed with any other medical conditions? (this includes any liver or kidney issues)
Do you suffer with any allergies?
Do you currently take any medication, this includes all prescription medications, any herbal medications or over the counter purchased medications? (this also includes any recreational drugs including poppers or cocaine)
Is there any other information you would like to share with our prescribing team? If so, please provide more information
Next 
