We are now going to ask you a few questions so that we can give you the best medical care. This takes an average of 5 minutes to complete. We try our best to help our patients, but sometimes our online service is not able to meet all your needs. Please be honest and if you are unsure about any of the answers, check these with your GP first.

I am 18 years old or above
I am using this service on my own behalf and of my own free will and any treatment or advice is for my sole use only
I will see my GP if I need help filling out this form, reading or understanding this consultation
I understand my consultation will not be passed to the Men's Health Shop Online Doctor clinical team until I have successfully completed the payment

Consent(Required)

I confirm the above

There are many causes of Erectile Dysfunction (ED). Your online consultation will help you find the cause for your ED, provide advice on tests and, if suitable, prescribe treatment.

ED means that you regularly cannot get or keep an erection that is hard enough to have sex
We can prescribe medicines such as Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil (Levitra), Spedra and Vitaros which increase the blood flow to your penis and therefore improve erections
These are successful in up to 8 out of 10 of men
Although unlikely, some side-effects of these medications include: headaches, facial flushing, indigestion, nausea, light headedness, changes in vision
Certain medical conditions, medications and recreational drugs containing nitrates can have dangerous interactions with ED medications. We will ask you about these in your consultation so please answer questions honestly so that we can prescribe for you safely

Consent(Required)

I confirm the above

What is your sex?(Required)

Male

Female

What is your date of birth?(Required)

For example: 31 3 1980

Your Consultation

How did your ED begin?(Required)

Suddenly

Gradually

Do you get normal erections in the mornings or when you masturbate?(Required)

Yes

No

Has your sex drive gone down?(Required)

Yes

No

Do you have, or have you ever had, any heart conditions?(Required)

Yes

No

Have you ever had a stroke or mini-stroke (TIA)?(Required)

Yes

No

Do you have any of the following blood pressure problems?(Required)

High blood pressure

Low blood pressure

Dizziness or lightheadedness when standing up

None of the above

Do you have a blood clotting condition that increases your risk of having blood clots, such as sickle cell anaemia, multiple myeloma or leukaemia?(Required)

Yes

No

Do you have a condition that affects your blood's ability to clot and makes you more prone to bleeding?(Required)

Yes

No

Have you ever had a liver condition?(Required)

Yes

No

Have you ever had a kidney condition?(Required)

Yes

No

Have you ever suffered from sudden loss of vision in one or both eyes?(Required)

Yes

No

Do you suffer from any inherited eye disorders such as retinitis pigmentosa?(Required)

Yes

No

If you have been prescribed a Nitrate medication you can not take ED medications due to a serious interaction. Nitrates are tablets, sprays, patches or gels used to treat:

Heart conditions
Anal fissures, tears near the anus (different to haemorrhoids or piles)

The following are Nitrates, you can find a list of the brand names under the information icon if you need:

Isosorbide mononitrate
Glyceryl trinitrate
Isosorbide dinitrate
Nicorandil

Nitrate medication(Required)

Yes, I have been prescribed a Nitrate medication

No, I have not been prescribed a Nitrate medication

Other

Are you currently taking any prescription medications?(Required)

Yes

No

Do you have any allergies?(Required)

Yes

No

Please enter your height(Required)

in cm, eg. 173.74 cm

Please enter your weight(Required)

in kg. eg 75 kg

Have you taken any medications for erectile dysfunction before?(Required)

Yes

No

Name(Required)

First Last

Phone(Required)

Email(Required)

Do you have a prescription?

Max. file size: 2 MB.

Upload your medical script

Please confirm the following to complete your consultation:

I have responded honestly and provided complete and accurate information that reflects my up to date medical history and information, so that the clinician can safely assess and advise me.
I fully understand all the questions and information provided. If I am unsure about any aspect of the service I will contact before proceeding.
I understand the side effects, effectiveness and alternatives to the treatment I am requesting.
I understand the importance of notifying my GP about medicines and advice I may receive from this service so they can continue to provide safe medical care
I understand this consultation will form part of my Online Doctor medical record and will be kept in line with the relevant retention period
I have read, understand and agree to the terms and conditions and privacy notice.

Consent(Required)

I confirm the above

Name

This field is for validation purposes and should be left unchanged.

Maintenance Pack – Tadalafil 10mg + L-Arginine – 30 capsules

Online Consultation

Your Consultation

Maintenance Pack – Tadalafil 10mg + L-Arginine – 30 capsules

Online Consultation

Your Consultation

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