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Medical Consultation

Complete this quick 2-minute questionnaire. A licensed US clinician will review your information.

Selected treatment:

Personal Information

First Name *

Last Name *

Date of Birth *

Email *

Phone Number *

Medical History

Do you have any of the following conditions? *

Heart disease or heart problems High or low blood pressure Stroke or mini-stroke Liver or kidney problems None of the above

Are you currently taking any medications? *

Do you take nitrates for chest pain? *

Yes No

ED medications cannot be prescribed if you take nitrates

Do you have any allergies? *

About Your Condition

How long have you been experiencing ED symptoms? *

Have you tried ED medication before? *

Yes No

Additional information (optional)

I certify that the information provided is accurate and complete. I understand that a US-licensed clinician will review my information and determine if treatment is appropriate. I agree to the Terms of Service and Privacy Policy. *

Please don't leave this page. After submitting, a clinician will review your information in approximately 1 minute. You'll receive your approval and payment link on this page.

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Clinician Reviewing Your Information

A licensed US clinician is carefully reviewing your medical history and consultation form. This typically takes about 1 minute.

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Prescription Approved!

Great news! Our clinician has reviewed your information and approved your prescription for .

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Disclaimer: This website provides information for educational purposes only and is not medical advice. Always consult with a healthcare professional before starting treatment.