How do you want to improve your sex life?

Are you looking to get hard faster and stay hard longer?

Do you want to boost your confidence in the bedroom? 

What bedroom boost are you looking for?

When did you start noticing your symptoms?

Which symptoms have you experienced?

Select all that apply.

How often have you experienced these symptoms?

How would you like to approach treatment options?

What state are you in?

We need to make sure your state allows telehealth.

Which best describes your current relationship status?

When are you typically most interested in having sex?

How satisfied are you with your daily energy levels?

Are you satisfied with your physical performance (e.g., workouts, endurance, recovery)?

Do you feel like you get enough essential vitamins and nutrients?

How active are you?

Is this treatment for you or someone else?

How often do you have difficulty getting or staying as hard as you want before ejaculating?

Which of the following best describes your sexual performance?

Which of the following best describes how this started?

During masturbation, how would you rate the typical hardness of your erection?

With a sexual partner, how would you rate the typical hardness of your erection?

Have you ever taken prescription medication to help improve your erections?

Are you able to climb up 2 flights of stairs, walk 4 blocks on flat terrain or engage in sexual activity without needing to stop because of physical symptoms?

Have you experienced severe lightheadedness, fainting or near fainting in the last 6 months?

Have you ever been diagnosed with or prescribed medication for any of the following conditions?

For any of the conditions you chose, please explain. 

Have you ever been diagnosed with a mental health or psychiatric condition?

We're asking so we can personalize your treatment for you.

Do you have or have you previously been diagnosed with any of the following heart conditions?

Do you have any other medical conditions you haven't shared with us already?

Be sure to include any medical conditions that you treat with medications. Type none, if this does not apply.

Do you take any prescription or non-prescription medications or supplements to improve your mental health?

Do you have any drug or food allergies?

Please list all drugs and food that you are allergic to and the reaction that each allergy causes 

(e.g., rash, anaphylaxis, nausea).

Do you have any other medical condition(s) you want to tell your doctor?

Surgeries, prior conditions, etc.

Please list your medical condition(s), any prior surgeries, or other message to your doctor.

Please include the name, dose, and frequency of all medications you are currently taking.

Or if not taking any medications, please type none

You're almost done! 

Click "Next" to see if you're eligible for treatment.