Help us understand the severity of your issue
To continue, please fill in or correct the fields marked with red text.
If you need help, call support at 1 (855) 632-6940
How did your ED start?
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How often do you suffer from ED?
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How often do you experience difficulty getting or maintaining an erection?
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Pick the scenario that best describes your ED.
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Rate the typical hardness of your spontaneous erections in the middle of the night or in the morning.
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Rate the typical hardness of your erection with a sexual partner.
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How are you feeling?
Is your desire to have sex noticeably lower than it has been in the past?
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Do you have a lack of energy?
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Do you have a decrease in strength and/or endurance?
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Are you sad and/or grouchy?
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Tell us a little more about you
What was your last blood pressure reading? You can find this information from a recent medical visit or by taking your blood pressure at a local pharmacy or grocery store. If you're not sure, you can leave this blank.
Do any of the following cardiovascular risk factors apply to you?
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Do you experience any of the following cardiovascular symptoms?
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Do you have or have you previously been diagnosed with any of the following?
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Do any of the following apply to you?
Let's find the right treatment for you
Have you ever been treated with medication for ED? If yes, what was your treatment and was it successful?
Is there anything else related to treatment that you'd like to ask or discuss with your medical provider?
Is there a type of treatment you prefer?
Would you like to share anything else with your provider through an upload?
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