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.
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After penetration do you usually ejaculate within 2 minutes?
Does premature ejaculation directly or indirectly cause you distress within your sexual relationships or within any other part of your life?
Do you have any difficulty getting or maintaining an erection?
Have you or do you suffer with any of the following symptoms?
- Pain while ejaculating
- Difficulty passing urine
- Pain in the testes
- Feeling faint or dizzy when standing up after sitting or lying down
Do you suffer from low blood pressure (below 90/50) or ever fainted or collapsed due to your blood pressure?
Have you ever been diagnosed with any other medical conditions?
This can include:
-Immune system conditions such as HIV
-Liver or kidney issues
Do you suffer with any allergies?
Do you currently take any medication? This includes herbal remedies and over the counter medication.
Is there any other information you would like to share with our prescribing team?
If so, please provide more information
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