Do you agree and consent to the following:

I am over 18 years old and live in the UK.

I will be the sole user of any medication offered to me through this service.

I confirm all answers are provided by me and are completely truthful.

Can you always get an erection when you want to?

Have you used any erectile dysfunction medication before?

Have you ever had a painful erection?

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 have, or have you ever had, any problems with your heart, liver or kidneys?

Have you ever had a stroke?

Do you currently have, or are you using treatment for any of the following:
Please select the option(s) that apply

Do you have any blood conditions like myeloma, leukaemia, sickle cell disease or haemophilia?

Do you have any of the following conditions?

Are you currently using any of the following medications:
Please select all that apply.

Are you currently using any other medication, even if you’re not using it regularly?

Do you have any other medical conditions? Please provide details

Are you allergic to any medications or substances?
For example, lactose, peanuts, or soya

Please provide details