Part 2 of 4
Long-term medical condition & History
Which of these best describes your experience?
Difficulty getting an erection
Struggling to achieve an erection initially during sexual activity
Difficulty maintaining an erection
Ability to get an erection but difficulty keeping it for the duration of activity.
Do you have any heart conditions?
This includes high blood pressure, angina, irregular heartbeat, or previous heart attacks. some treatments can place extra strain on your heart.
Yes
No
Any recent health condition?
In the last 6 months, have you experienced any heart-related issues (arrhyhmia, heart attack, angina)?
Yes
No
Do you have high blood pressure?
above 160/90 or are you or are you on treatment for high blood pressure?
Yes
No
Do you have low blood pressure?
Yes
No
Have you ever had an erection lasting longer than 4 hours (priapism)?
Yes
No
Do you have inherited eye disease such as retinitis pigmentosa?
Yes
No
Do you have inherited eye disease such as retinitis pigmentosa?
Yes
No
Have you ever been diagnosed with peyronie’s disease or any eye conditions like NAION?
Kindly indicate if you have ever been medically diagnosed with Peyronie’s disease or any optic nerve condition, including Non-Arteritic Anterior Ischaemic Optic Neuropathy (NAION).
Yes
No
Do you have liver disease or severe kidney impairment?
Yes
No
Do you have any bleeding disorders or active stomach ulcers?
Yes
No
Do you have multiple myeloma or serious medical conditions requiring hospitalisation?
Yes
No
Recent hospital visits or surgeries
Please list any operationsor inpatient treatment you have receieved in the last 6 months. This helps us ensure you are fully recovered
Add another entry
CQC Regulated
GPhC REGISTERED
Need help? call +44 907 154 0381 or Live chat
