Name: Erectile Dysfunction | GetCareMD
Price: 49.95 USD
Availability: InStock

Explain your symptoms or tell us how we can help today.*

Do you have allergies to any medications?*

Yes
No

If yes, please list any medications you have allergies to:

What symptoms have you been experiencing recently?*

Trouble getting an erection
Trouble maintaining an erection
Erection is too soft for intercourse
Anxiety leading up to intercourse
Reduced sex drive
I don’t have any of these symptoms

How Long have you been having these symptoms?*

Started today
1-3 days
4-7 days
Over 1 week

Have you ever been treated for erectile dysfunction?*

Yes
No

How long ago?*

What medication were you treated with?*

Describe the treatment plan:*

Did treatment work?*

Yes
No

Would you prefer the same treatment?*

Yes
No
Leave to doctor’s discretion

Smoker?*

Yes
No
Never

Alcohol use?*

Any medical family history?*

Yes
No

Please explain your medical family history:*

Do you have any medical conditions?*

Yes
No

Please explain your medical conditions:*

Have you ever had any surgeries or recent hospitalizations?*

Yes
No

Please explain your surgeries or recent hospitalizations:*

Do you currently take any medications, herbals, or supplements?*

Yes
No

Please list any medications, herbals, or supplements:*

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Erectile Dysfunction

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