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FORM 1/4

INITIAL ASSESSMENT

Are you male with age 18 to 75?
Yes
No
Have you taken any erectile dysfunction medication before ?
Yes
No
Do you have trouble achieving or maintaining your erection?
Yes
No
In the past 6 months, how often do you have difficulty getting and/or sustaining an erection during sexual activity?
Always
Often
Occasionally

How does this work?

Step 1: Fill out quick form

Step 2: Select your treatment

Step 3: Complete the payment and you will get your delivery.

Answer few quick and easy questions to see what treatments you are eligible for ...

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