If at all possible please fill out the form on your desktop. The form might not display properly on certain devices.

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This is an opportunity for you to tell your doctor about your health, medical history, and lifestyle. Your doctor will use this information to evaluate your symptoms and, if appropriate, prescribe medication for treatment. The online visit should not take you more than 20 minutes to complete. Please note, the questionnaire cannot be saved and completed later. Make sure you have 20 minutes of uninterrupted time to complete this step.

Once done you will need to have either a face to face or telemed consult with one of our physicians. The causes of Erectile Dysfunction are varied. From cardiovascular, to psychological to medication-related problems so please answer all questions truthfully.