NHS & Private Services Available

Premature Ejaculation

Do you think you have premature ejaculation?
How long have you been experiencing premature ejaculation?
How often do you feel affected by premature ejaculation?
How soon after entering your partner do you ejaculate?
Do you think you have control of when you ejaculate?
Does premature ejaculation cause distress or difficulties in your sex life?
Have you tried any medication for premature ejaculation before?
Can you always get and maintain an erection when you want one?
Can you always get and maintain an erection when you want one?
Do you have any heart conditions such as heart failure, ischaemic heart disease, heart valve problems, heart rhythm problems or peripheral vascular disease?
Do you have, or have you ever had, a condition such as mania, bipolar disorder or schizophrenia?
Are you experiencing depression or anxiety, or are you currently taking antidepressant medications?
Do you have any neurological conditions such as epilepsy, or fainting episodes due to low blood pressure?
Do you have any blood clotting disorders or take any medication that affects your blood clotting?
Do you have any liver or kidney conditions?
Do you have any eye conditions such as glaucoma?
Do you have any prostate conditions such as prostatitis or benign prostatic hypertrophy?
Do you have any hormone conditions such as thyroid problems or hypogonadism (low testosterone levels)?
Do you have any other medical conditions not mentioned already?
Are you currently taking any medication, or have you recently finished a course of medication?
Are you allergic to any medicines or other substances? | For instance lactose.
Please tick all of the allergies that apply to you.
On average, how much alcohol do you drink per day?
alcohol
Have you taken any illegal drugs or 'legal highs' in the last 6 months?
drugs
Checkboxes
Your request
What’s Your Birth Gender?
Name
Select pharmacy for collection
Nationwide Delivery
Do you agree and consent to the following? You are completing this consultation for yourself and to the best of your knowledge. You will disclose any medical conditions, serious illnesses or operations you have had. You will disclose any prescription medications you are currently taking and agree to use only use one weight loss treatment at a time. You agree to our Terms & Conditions, Terms of Sale, and confirm that you have read our Privacy Policy. Your accurate and honest responses to this online questionnaire for weight loss treatment are crucial. Withholding or providing false information can severely harm your health and may result in life- threatening consequences. By filling out this questionnaire, you confirm that your responses are truthful and accurate, acknowledging the potential risks of misinformation.
Privacy Policy