Before We Get Started There are many causes of Erectile Dysfunction (ED). Your online consultation will help you find the cause for your ED, provide advice on tests and, if suitable, prescribe treatment. *

• ED means that you regularly cannot get or keep an erection that is hard enough to have sex • We can prescribe medicines such as Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil (Levitra), Spedra and Vitaros which increase the blood flow to your penis and therefore improve erections • These are successful in up to 8 out of 10 of men • Although unlikely, some side-effects of these medications include: headaches, facial flushing, indigestion, nausea, light headedness, changes in vision • Certain medical conditions, medications and recreational drugs containing nitrates can have dangerous interactions with ED medications. We will ask you about these in your consultation so please answer questions honestly so that we can prescribe for you safely

I understand

Name *

First Name

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To help us advise on the best treatment for you, please tick if you have any of the following:

Tick any that apply.

A prostate condition

A stomach ulcer diagnosed in the last 6 months

Diabetes, pre-diabetes or high sugars

A rare, inherited condition where I am unable to metabolise sugars (not diabetes)

High cholesterol

Lactose intolerance

Multi-System Atrophy (MSA)

Parkinson's disease

Problems with passing urine

Please confirm the following to complete your consultation: *

• I have responded honestly and provided complete and accurate information that reflects my up to date medical history and information, so that the clinician can safely assess and advise me. • I fully understand all the questions and information provided. If I am unsure about any aspect of the service I will contact before proceeding. • I understand the side effects, effectiveness and alternatives to the treatment I am requesting. • I understand the importance of notifying my GP about medicines and advice I may receive from this service so they can continue to provide safe medical care. • I understand this consultation will form part of my Online Doctor medical record and will be kept in line with the relevant retention period. • I have read, understand and agree to the terms and conditions and privacy policy.

I confirm to the above.