Erectile Dysfunction Consultation

You must fill in the following form before you can purchase your Erectile Dysfunction treatment

Erectile Dysfunction Consultation

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 so, please provide more information

Please provide more details

If you have previously used erectile dysfunction treatment- did you ever experience any side effects?

If so, please provide more information

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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)

If so, please provide more information

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Do you suffer with any allergies?

If so, please provide more information

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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)

If so, please provide more information

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Is there any other information you would like to share with our prescribing team?

If so, please provide more information

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We strongly recommend that you inform your GP of any treatment you receive. Would you like WePrescribe to do this on your behalf?

I have read and understood the Terms and Conditions.

Please see our terms and conditions here