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Note: You will be able to select and add a suitable treatment to your cart after completing the consultation. Our prescribers will issue a FREE prescription as per your treatment suitability. If your consultation is approved, you will be offered treatment for you and the prescriber to jointly consider. However, the final decision always will be the prescriber's.


Learn more about Erectile Dysfunction on the NHS website.

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We provide an online prescription service that you can use to get this medication delivered discreetly straight through to your door. You should always consult your doctor.
Can we help?If you require urgent assistance, do not use this service. Call 111 for NHS services or 999 in an emergency.

ABOUT YOU

Are you a male between the ages of 18-75?

Do you smoke or drink?

YOUR SYMPTOMS

Do you have any problems getting an erection, or keeping one as long as you want to?

YOUR HEALTH

Have you been advised to avoid heavy exercise by your GP or other healthcare professionals?

Do you often get breathless or have chest pain when you do light exercise, like walking up stairs?

In the last 6 months, have you been told by a doctor to avoid physical or sexual activity?

Do you suffer from depression that you have not seen your GP about?

Have you ever suffered from any of the problems listed below?

  • Any heart problems including angina, chest pain, heart failure, irregular heart beats, heart attack (myocardial infarction), left-ventricular outflow obstruction, cardiomyopathy or valvular heart disease (e.g.aortic stenosis).
  • Stroke
  • Sight loss due to poor circulation
  • Sight loss because of non-arteritic anterior ischemic optic neuropathy (NAION)
  • Blood problems such as haemophilia, sickle cell anaemia (an abnormality of red blood cells),leukaemia (cancer of blood cells) or multiple myeloma (cancer of bone marrow)
  • Stomach ulcers (e.g. peptic/gastric ulcer)
  • Liver problems
  • Kidney problems
  • An erection that lasted more than 4 hours
  • Any physical condition affecting the shape of the penis (e.g. angulation, Peyronie’s disease and cavernosal fibrosis)
  • Inherited eye disease - retinitis pigmentosa
  • Multiple myeloma (cancer of the bone marrow)
  • Galactose intolerance, Lapp Lactase deficiency or glucose-galactose malabsorption
  • Any serious medical condition which may require immediate hospitalisation

YOUR MEDICATION

Have you used any erectile dysfunction medication before?

Do you have any allergy to Viagra (sildenafil), Levitra (vardenafil), Spedra (avanafil) or Cialis (tadalafil) or have you experienced any adverse reaction to any erectile dysfunction medication previously?

Are you taking any medicines known as nitrates (often taken for chest pain/angina) or nitric oxide donors ('poppers')?

  • Often taken for chest pain/angina
  • Can be administered as a spray, tablet or patch.
  • Include glyceryl trinitrate, isosorbide mononitrate or isosorbide dinitrate

Are you currently taking any medication (including over the counter, prescription or recreational drugs)?

AGREEMENT

Fill in this field if you would like us to notify your GP surgery.

Do you agree with the following?

  • You will read the patient information leaflet supplied with your medication
  • You fully understand the questions in this questionnaire and have answered honestly and truthfully
  • You fully understand the side effects of the treatment options, their effectiveness and alternative options, and are happy to continue with your request
  • You will contact us and inform your GP of your medication if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment.
  • You confirm and agree that any treatment prescribed for you is for your personal use only
  • understand that you should not take more than one type of ED medication on the same day
  • You give permission to access you NHS Summary Care Record in order to identify you correctly, check your medical history and provide the best possible care
  • You give permission to contact your GP to inform them of your treatment
  • You understand our prescribers take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health.
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